title: Atherosclerotic renal artery stenosis:  update on management strategies.
abstract: OBJECTIVE
  Atherosclerotic renal artery stenosis (ARAS) usually occurs in patients at high risk of vascular disease, and is associated with increased mortality. The primary goals of ARAS treatment include the control of blood pressure (BP), the improved renal function, and the benefit on cardiovascular events. Although medical therapy remains the standard approach to the management of ARAS, percutaneous transluminal renal angioplasty (PTRA) revascularization can be a therapeutic option under certain conditions.
  
  
  RESULTS
  Recent evidence confirms that ARAS increases cardiovascular risk, independent of BP and renal function. This suggests that revascularization might potentially improve overall prognosis, but no data are available currently. In cases of significant ARAS, the accepted indications for PTRA are uncontrollable hypertension, gradual or acute renal function decline with the use of agents blocking the renin-angiotensin-aldosterone system, and recurrent flash pulmonary edema. The key point of treatment success remains in all cases a careful patient selection.
  
  
  CONCLUSIONS
  Although the atherosclerotic lesions of the renal arteries tend to progress over time, the anatomical lesion progression is not always associated with changes in BP. Furthermore, a poor correlation was noted between the degree of anatomic stenosis and glomerular filtration rate. The high cardiovascular risk warrants aggressive pharmacological treatment to prevent progression of the generalized vascular disorder. Ongoing trials will show whether PTRA revascularization has added, long-term effects on BP, renal function, and cardiovascular prognosis. With or without PTRA revascularization, medical therapy using antihypertensive agents, statins, and aspirin is necessary in almost all cases.
authors.affiliation: Service of Nephrology, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne and Division of Nephrology, Department of Medicine, Hôpital du Valais, Sion, Switzerland. pascal.meier@chuv.ch
authors.forename: Pascal
authors.initials: P
authors.lastname: Meier
mesh_terms: D000924:Anticholesteremic Agents / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D050379:Arteriolosclerosis / Q000188:drug therapy* / Q000628:therapy; D001794:Blood Pressure; D018450:Disease Progression; D006801:Humans; D006978:Hypertension, Renovascular / Q000517:prevention & control*; D011379:Prognosis; D012078:Renal Artery Obstruction / Q000188:drug therapy* / Q000628:therapy; D012084:Renin-Angiotensin System / Q000187:drug effects; D018570:Risk Assessment / Q000379:methods; D040242:Risk Reduction Behavior; D015607:Stents; D013927:Thrombosis / Q000188:drug therapy* / Q000628:therapy
chemical_list: D000924:Anticholesteremic Agents; D000959:Antihypertensive Agents