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Renal artery stenosis and ischemic nephropathy.

Renal artery stenosis (RAS), in its most severe form, can result in diminished renal function and loss of kidney mass. The prevalence of ischemic nephropathy is greatly under-appreciated in the elderly population and is the source of substantial morbidity and mortality. Diagnostic tests for RAS in patients with renal insufficiency are problematic, and medical therapy does little to slow the natural progression of the disease. Renal artery stenting can achieve long-term vessel patency and has been shown to preserve renal function. Proper technique and careful case selection are critical to the success of such procedures. Large-scale trials are needed to clearly identify groups of patients who will benefit most from percutaneous revascularization.