Renal Artery Stenosis: Diagnostic and Management Problems


  • Nur Samsu Division of Nephrology and Hypertension, Department of Internal Medicine, Faculty of Medicine, Universitas Brawijaya – dr. Saiful Anwar, General Hospital, Malang
  • Affa Kiysa Waafi Department of Internal Medicine, Faculty of Medicine, Universitas Brawijaya – dr. Saiful Anwar, General Hospital, Malang



renal artery stenosis, diagnosis, medical management, revascularization


Renal artery stenosis is one common clinical problem. It has wide spectrum of pathophysiology with 3 most common clinical syndromes, ischemic nephropathy, hypertension, and cardiac destabilization syndrome. Aim: To date there was not any specific diagnostic criteria for renal artery stenosis. Method: Clinicians only used some clinical syndromes to guide the diagnostic possibility of renal artery stenosis. RADUS as one sensitive and specific diagnostic method, still had some disadvantages. Results: it gives false negative results in 10-20% of patients due to confounding factors such as operator capability, obesity, or abdominal gas distribution. CTA and MRA was excellent, but possessed some risks for the patient. Therefore, CTA was mostly recommended in patient with the planning of revascularization. Management of renal artery stenosis was still debated between optimal medical management and revascularization because the complexities of mechanisms underlying the renal artery stenosis. Because of the complicated pathophysiology of renal artery stenosis, revascularization could not entirely improve renovascular hypertension and nephropathy. Revascularization offered best results in fibromuscular dysplasia, although procedure related complication was still high. Revascularization, even though it might have high success rate in atherosclerotic renal artery stenosis, but the incidence of re-stenosis was also fairly high. Conclusion: Overall, revascularization was recommended in FMD, but should only be preserved for atherosclerotic renal artery stenosis after the failure of optimal medical management.


Cho NH, Whiting D, Forouhi N, Guariguata L, Hambleton I, Li R, et al. IDF Diabetes Atlas In: Federation ID, editor. 2015.

Gottam N, Nanjundappa A, and Dieter RS. Renal artery stenosis: pathophysiology and treatment. Expert Rev.Cardiovasc. Ther. 2009. 7 (11): 1413-1420.[doi: 10.1586/erc.09.109]

Weber BR, and Dieter RS. Renal artery stenosis: epidemiology and treatment. International Journal of Nephrology and Renovascular Disease, 2014; 7: 169-181.[doi: 10.2147/IJNRD.S40175]

Bavishi C, de Leeuw PW, and Messerli FH. Atherosclerotic renal artery stenosis and hypertension: pragmatism, pitfalls, and perspectives. The American Journal of Medicine, 2016, 129: 635.e5-635.e14. [doi:]

Kasper DL, Hauser SL, Jameson JL, et al. Harrison’s Principles of Internal Medicine 19th ed. USA: The McGraw-Hill Companies Inc. 2015.

Parikh SA, Shishehbor MH, Gray BH, et al. SCAI Expert Consensus Statement for Renal Artery Stenting Appropriate Use. Catheterization and Cardiovascular Intervention, 2014, Wiley Online Library. []

Goyez JCR, Gomez NIJ. Challenges in diagnosing and treating a patient with renal artery fibromuscular dysplasia: case report. European Heart Journal – Case Report, 2019, 3: 1-6. [doi:10.1093/ehjcr/yty144]

Al-Suraih M, Grande JP. Management of renal artery stenosis: What does the experimental evidence tell us? World J Cardiol, 2014, August 26; 6 (8): 855 – 860. [doi: 10.4330/wjc.v6.i8.855]

Walker BR, Colledge NR, Ralston, SH., et al. Davidson’s Principles and Practice of Medicine 22nd ed. USA: Elsevier Inc. 2014.

Kumar, Parveen and Michael Clark. 2017. Kumar & Clark’s Clinical Medicine 9th ed. USA: Elsevier Inc.

Hall, John E. 2016. Guyton and Hall Textbook of Medical Physiology 13th ed. USA: Elsevier Inc.

Saragih, Wendy M. Case report of secondary hypertension due to renal artery stenosis in young patient. Med J Indones, 2014, 23 (2): 117-121. [doi:10.13181/mji.v23i2.666]

Colyer, WR., Eltahaway, E., Cooper, CJ. Renal artery stenosis: optimizing diagnosis and treatment. Prog Cardiovasc Dis, 2011; 54 (1): 29-35. [doi: 10.1016/j.pcad.2011.02.007]

McLaughlin, K., Jardine, AG., Moss, JG. ABC of Arterial and Venous Disease: Renal artery stenosis. BMJ Volume 320, April 2000.


Taylor DC, Kettler MD, Moneta GL, et al. Duplex ultrasound scanning in the diagnosis of renal artery stenosis: a prospective evaluation. J. Vasc. Surgery, 1988, 7, 363-369. [doi:10.1016/0741-5214(88)90156-5]

Olin JW, Piedemonte MR, Young JR, et al. The utility of duplex ultrasound scanning of the renal arteries for diagnosing significant renal artery stenosis. Ann. Intern. Med. 1995. 122, 833-838. [doi: 10.7326/0003-4819-122-11-199506010-00004]

Vasbinder, GBC, Nelemans PJ, Kessels AGH, et al. Accuracy of computed tomographic angiography and magnetic resonance angiography for diagnosing renal artery stenosis. Ann. Intern. Med. 2004. 141, 674-682. []

Postma CT, Joosten FB, Rosenbusch G et al. Magnetic resonance angiography has a high reliability in detection of renal artery stenosis. Am. J. Hypertens. 1997. 10, 957. [doi: 10.1016/s0895-7061(97)00157-x]

Williams GJ, Macaskill P, Chan SF, et al. Comparative accuracy of renal duplex sonographic parameters in the diagnosis of renal artery stenosis: paired and unpaired analysis. Am. J. Roentgenol, 2007. 188, 798. [doi: 10.2214/AJR.06.0355 ]

Textor S. Atherosclerotic renal artery stenosis: overtreated but underrated. J. Am. Soc. Nephrol. 2008. 19, 656-659.


Dieter R. The functional assessment of renal artery stenosis. Expert Rev. Cardiovasc. Ther. 2005. 3(3), 269-370.

Jr Colyer WR, Cooper CJ, Burket MW, Thomas WJ. Utility of a 0.014†pressure sensing guidewire to assess renal artery translesional systolic pressure gradients. Catheter Cardiovasc Interv. 2003. 59, 372-377. [doi: 10.1002/ccd.10508]

Safian RD, Madder RD. Refining the approach to renal artery revascularization. JACC Cardiovasc. Intervention, 2009. 2, 161-174.


Wheatly K, Kalra PA, Moss J, et al. Lack of benefit of renal artery revascularization in atherosclerotic renovascular disease (ARVD). Results of the ASTRAL trial (abstr.). J. Am. Soc. Nephrol. 2008. 19, 656-659.

Cheung CM, Hegarty J, Kalra PA. Dilemmas in the management of renal artery stenosis. British Medical Bulletin, 2005, 73 & 74: 35-55.


Tegtmeyer CJ, Elson J, Glass TA, et al. Percutaneous transluminal angioplasty: the treatment of choice for renovascular hypertension due to fibromuscular dysplasia. Radiology, 1982. 143, 631-637. [doi: 10.1148/radiology.143.3.6210930 ]

Rocha-Singh K, Michael RJ, Kenneth R. Evaluation of the Safety and Effectiveness of Renal Artery Stenting after Unsuccessful Balloon Angioplasty: The ASPIRE-2 Study. Journal of the American College of Cardiology, 2005, 46, 5: 776-783. []

The ASTRAL Investigators. Revascularization versus Medical Therapy for Renal Artery Stenosis. N Engl J Med, 2009; 361: 1953-1962. [doi: 10.1056/NEJMoa0905368]

Murphy TP, Cooper CJ, Dworkin LD, et al. The Cardiovascular Outcomes with Renal Atherosclerotic Lesions (CORAL) Study: Rationale and Methods. J Vasc Interv Radiol, 2005; 16: 1295-1300.


Leertouwer TC, Gussenhoven EJ, Bosch JL, et al. Stent placement for renal arterial stenosis: where do we stand? A meta-analysis. Radiology 2000; 216:78–85. [doi: 10.1148/radiology.216.1.r00jl0778 ]

Cooper CJ, Murphy TP, Cutlip DE, et al. 2014. Stenting and Medical Therapy for Atherosclerotic Renal-Artery Stenosis. N Eng J Med, 2014, 370: 13-22. [doi: 10.1056/NEJMoa1310753]

Bax L, Woittiez AJ, Kouwenberg HJ, et al. Stent Placement in Patients with Atherosclerotic Renal Artery Stenosis and Impaired Renal Function. A Randomized Trial. Ann Intern Med, 2009; 150: 840-848.[doi: 10.7326/0003-4819-150-12-200906160-00119