Controversies in renal artery stenosis: A review by the American Society of Nephrology Advisory Group on hypertension

Renovascular hypertension is a recognized secondary potentially curable cause of hypertension since the work of Harry Goldblatt. Operative treatments for renal artery stenosis (RAS) have been offered for decades and percutaneous interventions have been widely available for 20 years. Stenting has largely obviated recurrence and modern techniques have contributed greatly to the safety of the procedure. Nevertheless, controversy abounds and prospective randomized trials have not successfully documented the value of intervention in patients with atherosclerotic RAS. The patient population has also changed remarkably. Whereas earlier patients with RAS were identified on clinical grounds, RAS is now commonly found serendipitously during angiography for other reasons. Whether or not these patients benefit from 'drive by' stenting is unknown. The practice may be hazardous and should be critically examined. A dialog and closer cooperation between cardiologists and nephrologists is warranted and organized programs should be formulated to address this problem.