Progressive hypertension in a patient with "incidental" renal artery stenosis

Taken together, this man's history illustrates one prone to atherosclerotic disease affecting multiple vascular beds at a relatively young age. Renal artery lesions were identified at a time before they produced significant hypertension or renal dysfunction. They were followed as "incidental" renal artery stenosis. Whether screening for RAS should be considered routinely as part of angiographic procedures cannot be determined with the data available today. Forewarning of the presence of high-grade renal artery lesions in this individual allowed prompt intervention 2 years later when arterial hypertension progressed rapidly and aggravated symptoms of cardiac ischemia. Awareness of the time sequence and potential for progression of both anatomic and clinical manifestations of renal artery disease is important for clinicians caring for such patients, particularly during an era of rapidly changing imaging, medical therapy, and interventional techniques.