Current opinions in renovascular hypertension

Area of Science:

• Nephrology
• Cardiology
• Vascular Medicine

Background:

• Renal artery stenosis (RAS) and renovascular hypertension (RVH) are critical in managing resistant hypertension.
• RAS diagnosis has prognostic implications for chronic kidney disease progression.
• Atherosclerotic disease and fibromuscular dysplasia are the primary etiologies of RAS.

Purpose of the Study:

• To review the pathophysiology of renal artery stenosis.
• To discuss the diagnostic utility and limitations of various imaging modalities for RAS.
• To outline current treatment strategies for RAS and RVH.

Main Methods:

• Literature review of pathophysiology, diagnosis, and treatment of RAS.
• Analysis of pros and cons of imaging studies (e.g., Doppler ultrasound, CT angiography, MR angiography, digital subtraction angiography).
• Discussion of therapeutic interventions including medical management and revascularization.

Main Results:

• Pathophysiology involves reduced renal perfusion leading to renin-angiotensin-aldosterone system activation.
• Imaging choices depend on clinical context, with varying sensitivity and specificity.
• Treatment is multifactorial, addressing hypertension, cardiac risk, and potential revascularization.

Conclusions:

• RAS and RVH require careful consideration in hypertensive patients.
• Appropriate diagnostic imaging is crucial for timely intervention.
• Comprehensive management, including revascularization in select cases, improves outcomes.