Renal artery stenosis: current diagnosis and treatment

To provide an overview of the current approaches to management of renovascular disease.

A literature review was performed and key references are provided relating to diagnostic tests, particularly captopril renography and renal duplex scanning. Options for treatment are reviewed from published series to December 1991. We also draw on the experience of our own Unit.

Data and opinions from five general reviews of renovascular disease, 10 articles on diagnostic tests and five articles relating to therapeutic approaches are summarised.

There is no simple screening test for renovascular hypertension that can be applied to an unselected population of hypertensive subjects. The diagnosis depends on judicious use of non-invasive screening tests in those subjects in whom one suspects, on clinical grounds, that there may be an underlying renovascular lesion. Captopril renography and duplex scanning of renal arteries are the most reliable non-invasive screening tests. A team approach with collaboration of hypertension specialist/vascular physician, vascular surgeon and experienced interventional radiologist is important for rational management and we would emphasise the importance of audit procedures.