Renal-Artery Stenosis

doi:10.1056/NEJM200102083440607

Volume 344:431-442		February 8, 2001		Number 6

Renal-Artery Stenosis

Robert D. Safian, M.D., and Stephen C. Textor, M.D.

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Primary diseases of the renal arteries often involve the largerenal arteries, whereas secondary diseases are frequently characterizedby small-vessel and intrarenal vascular disease. In this article,we will concentrate on the two most common primary diseasesof the renal arteries — atherosclerotic renal-artery stenosisand fibromuscular dysplasia — and their association withtwo common clinical syndromes, hypertension and ischemic nephropathy.The relations among renal-artery stenosis, hypertension, andrenal excretory dysfunction are complex (Figure 1). Renal-arterystenosis may occur alone (isolated anatomical renal-artery stenosis)or in association with hypertension, renal insufficiency (ischemicnephropathy), or both.

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Figure 1. Interrelation among Renal-Artery . . . [Full Text of this Article]

Prevalence and Natural History

Renal-Artery Stenosis and Hypertension

Pathophysiology

Noninvasive Evaluation

Invasive Evaluation

Medical Therapy

Surgical Revascularization

Percutaneous Intervention

Effect of Revascularization on Hypertension

Ischemic Nephropathy

Pathophysiology

Clinical Characteristics

Noninvasive Evaluation

Medical Therapy

Renal Revascularization

Effect of Revascularization on Renal Function

Recommendations

Conclusions

Source Information

From the Division of Cardiology, Department of Medicine, William Beaumont Hospital, Royal Oak, Mich. (R.D.S.); and the Section on Hypertension and Nephrology, Department of Medicine, Mayo Clinic, Rochester, Minn. (S.C.T.).

Address reprint requests to Dr. Safian at William Beaumont Hospital, Division of Cardiology, 3601 W. 13 Mile Rd., Royal Oak, MI 48073, or at rsafian@beaumont.edu.

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