Renal artery stenosis

Abstract

Renal artery stenosis (RAS) is a common problem in patients with peripheral or coronary artery disease and is present in roughly 1–5 % of the 60 million Americans with hypertension. Furthermore, as the population ages, the prevalence increases. In the elderly, renal artery stenosis becomes far more common, with an incidence in patients over the age of 65 nearly 7 %. Historically this has been seen as a blood pressure problem, to a large extent based upon the seminal works of Goldblatt and colleagues. Substantial progress has been made in the understanding of the role of the angiotensin, aldosterone, sympathetic, prostaglandin, and oxidant systems in blood pressure regulation. In fact in the past decade, there is increasing awareness that for many patients, blood pressure can be effectively controlled with medications, albeit oftentimes several medications are required to control pressure. Unfortunately renal dysfunction is commonplace, and more importantly, patients with renal dysfunction have a strikingly high rate of adverse cardiovascular events.