The management of renovascular disease: ASTRAL and beyond

Purpose of review This review concentrates on the new findings published in the atheromatous renovascular disease (ARVD) literature since the beginning of 2009, a period in which the results of two randomized control trials have been released. Recent findings The key advances have arisen with respect to the epidemiology of ARVD, the effects of revascularization as demonstrated by the results of randomized controlled trials, an understanding of the pathophysiology of the ischaemic kidney, and also there have been further insights regarding the selection of patients for revascularization utilizing structural and functional imaging. Summary Optimal medical management (and not revascularization therapy) is the established cornerstone for all patients with ARVD. Future studies should be directed to identifying individuals who will significantly benefit from renal revascularization.