Natural history and progression of atherosclerotic renal vascular stenosis

SUMMARY OF THE EVIDENCE Atherosclerotic renal vascular disease is a progressivedisease, with high grade stenosis (>60%), systolic hyperten-sion (>160 mmHg) and diabetes associated with fasterprogression. Abnormal baseline creatinine and bilateralstenosis are associated with greater likelihood of deteriora-tion of renal function. Patients with ARVD have increasedmortality and morbidity, particularly from cardiovasculardisease. WHAT DO THE OTHER GUIDELINES SAY?Kidney Disease Outcomes Quality Initiative: No recom-mendation. UK Renal Association: No recommendation. Canadian Society of Nephrology: No recommendation. European Best Practice Guidelines: No recommendation. International Guidelines: No recommendation. SUGGESTIONS FOR FUTURE RESEARCH 1. Perform a large prospective study with ultrasound sur-veillance to look at risk factors for progression.2. Investigate the variability in progression rate when dif-ferent imaging modalities are used for follow up.3. Investigate the influence of lifestyle changes, statins,renin-angiotensin system blockade alone or in combinationon stenosis progression.