Renal Artery Stenosis: Recent Evidence, Evidence Gaps, and Practical Approaches to Diagnosis and Management

Management of renal artery stenosis requires understanding of complex pathophysiology, familiarity with both epidemiology and anatomic characteristics for accurate diagnosis, and appreciation of both evidence and evidence gaps. Approaches, diagnosis, and treatment of renal artery stenosis have changed rapidly over the past few decades. Although renal artery stenosis is a widely accepted cause of secondary hypertension (and complications resulting from consequent target organ damage), the role of renal artery revascularization for patients with symptomatic renal artery stenosis remains controversial. Enthusiasm for renal artery revascularization has been dampened by lack of observed benefit in randomized trials, but the results are not generalizable to all patients or clinical presentations. This article will review the pathophysiology, epidemiology, clinical presentation, diagnostic evaluation, and clinical management of renal artery stenosis in adults, focusing on atherosclerosis and fibromuscular dysplasia (the most common etiologies in adults). Review of clinical trials will focus on the most recent studies, including their outcomes, inclusion and exclusion criteria, and limitations.