Clinical management of atheromatous renovascular disease.

Renal artery stenosis (RAS) is common, being due to atheroma in over 90% of cases in developed countries with the remainder mainly due to fibromuscular disease (FMD). The latter tends to occur in younger patients, predominantly women, and usually presents with severe hypertension; a good outcome can be expected following angioplasty. Renal dysfunction is not normally a major concern with FMD. Atheromatous RAS lesions excite clinical interest because of the possibility for revascularisation that might improve the clinical presentation of hypertension, acute and chronic kidney disease (CKD) and/or heart failure. The lesions classically occur in patients with generalised macrovascular atheroma, often in combination with endorgan smaller vessel disease, notably ‘intrarenal’ disease. Atherosclerotic renovascular disease (ARVD) is therefore considered a systemic syndrome. Ischaemic nephropathy is the term used when reduced renal function occurs in association with renovascular disease.