Renal artery stenosis: diagnostic strategy and treatment

If essential hypertension is a disease of theories, then renovascular hypertension is a disease of experiments. No other form of experimental hypertension has been more widely studied. The pathophysiology of renovascular hypertension is known in great detail. The question, however, of how to translate the experimental knowledge into clinical practice is a different matter, and the answer is far from clear. The main difficulty is that renovascular hypertension in experimental animals is not the same as hypertension associated with renal artery stenosis in humans. Renal artery stenosis in humans is in most cases caused by atherosclerosis, a progressive disease quite different from the silver clip in experimental animals. In the kidney, atherosclerosis does not only affect the large arteries but also the small arteries and arterioles. Furthermore, atherosclerosis is not limited to the kidney, it also affects the heart and the brain. There is no cure for atherosclerosis; restenosis after angioplasty is still a daunting problem. Finally, renal artery stenosis can be a complication of essential hypertension or essential hypertension can coincide with renovascular hypertension. Renal artery stenosis may cause severe and refractory hypertension and it frequently does so. This will lead to multiple organ damage such as hypertensive retinopathy, left ventricular hypertrophy, coronary vascular disease, heart failure and cerebrovascular accident? Progression of renal artery stenosis to renal artery occlusion results in loss of kidney function, and, in case of bilateral renal artery involvement or in the presence of atherosclerotic disease of smaller renal arteries, it will lead to end-stage renal failure.