Renovascular Hypertension and Ischemic Nephropathy

Advances and major points of emphasis: (1) Definition of the spectrum of clinical manifestations related to renovascular disease. (2) Recognition that moderate reductions in renal blood flow are tolerated without tissue hypoxia or damage, thereby allowing medical therapy of most patients with renovascular hypertension. (3) Appreciation that fibromuscular disease and other conditions differ from atherosclerotic disease regarding “competing risks.” (4) Integration of limited prospective trial results for atherosclerotic disease into clinical practice supporting optimized medical therapy using agents that block the renin-angiotensin system. (5) Identification of high-risk subsets that may have mortality benefits associated with renal revascularization. (6) Establishing the limits of kidney adaptation to reduced perfusion, beyond which tissue hypoxia and activation of inflammatory pathways ensue.