Clinical characteristics of atherosclerotic renovascular disease

In addition to its role in secondary hypertension, ischemic renal disease is becoming recognized as a significant cause of renal insufficiency. The prevalence and natural history of this disease remain unknown due to difficulty in identification of the process. There are several scenarios that may help alert the clinician to the presence of atherosclerotic renovascular disease. In hypertensive patients, poorly controlled blood pressure on several medications or rapid acceleration of hypertension can suggest renovascular disease. In addition, high-grade retinopathy or abdominal bruits seem to be associated with this condition: bruits have the highest positive predictive value of the clinical signs. Renal artery stenosis also may be related to rapidly progressive renal failure. The classic association is renal failure after use of angiotensin-converting enzyme inhibitors; however, acute renal failure induced through any sudden therapeutic decrease in blood pressure may imply the presence of renal artery stenosis. Unexplained azotemia in the elderly patient also has been associated with renovascular disease. It is possible that the majority of patients with renal artery stenosis are those with a clinically silent process. Advanced age, peripheral atherosclerotic vascular disease, and coronary artery disease may all have a high association with stenosis of one or both renal arteries. It is nevertheless unknown whether a radiographically detected lesion implies current or future clinical complications.(ABSTRACT TRUNCATED AT 250 WORDS)