Diagnosis, treatment, and prognosis of renal artery stenosis

With the increasing age of the Population We Must be prepared for a higher number of patients with renal artery occlusive disease. The clinical importance of renal artery stenosis is the induction of severe hypertension and renal dysfunction or even dialysis dependency. In this context it is of importance to realize that the presence of renal artery stenosis is not always responsible for hypertension and renal dysfunction in the individual patient and that only a stenosis > 60-70% diameter reduction can be considered hemodynamically significant. Typical clinical symptoms are helpful to select patients for further screening methods. In this setting a prominent role of color duplex sonography is seen. Nevertheless, intraarterial angiography remains the gold standard. All treatment options (surgery, angioplasty and medical treatment alone) have specific advantages and disadvantages which should be considered in the individual case and must be reconsidered during follow-up. Independent of the treatment chosen, control of all cardiovascular risk factors needs consideration. The selection for invasive treatment requires a careful assessment of the hemodynamic significance of the stenosis, the presence of irreversible parenchymatous damage and the clarification of the treatment goals in the patient. The practical challenge for the clinician is to carefully consider the benefit and the risks associated with the various types of treatment and to select the best treatment for the individual patient.