Atherosclerotic renal artery stenosis (RAS) is present in substantial proportions of patients with end-stage renal disease, congestive heart failure, co-occurring diabetes and hypertension, and other atherosclerotic diseases. Atherosclerotic RAS is associated with markedly increased risks for cardiovascular events. RAS is less commonly caused by fibromuscular dysplasia, usually in women younger than age 40 years. The ACCF/AHA guidelines recommend screening for RAS with either duplex ultrasonography, magnetic resonance angiography, or computed tomographic angiography in patients with the conditions listed in the box below.

Conditions Suspicious for Renal Artery Disease

● Onset of hypertension at age ≤30 years

● Onset of severe hypertension at age ≥55 years

● Accelerated (sudden and persistent worsening of previously controlled hypertension), resistant (not controlled with three drugs), or malignant hypertension (evidence of acute end-organ damage)

● New worsening of renal function or worsening function after use of an angiotensin-converting enzyme inhibitor or an angiotensin-receptor blocking agent

● An unexplained small kidney or size discrepancy of >1.5 cm between the two kidneys

● Sudden unexplained pulmonary edema, especially in the setting of worsening renal function

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