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(Circulation. 2005;112:1362-1374.)
© 2005 American Heart Association, Inc.

Contemporary Reviews in Cardiovascular Medicine

Renovascular Hypertension and Ischemic Nephropathy

Vesna D. Garovic, MD; Stephen C. Textor, MD

From the Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minn.

Correspondence to Stephen C. Textor, MD, W9A, Mayo Clinic, Rochester, MN 55905. E-mail textor.stephen@mayo.edu

Key Words: hypertension, renal • hypertension, renovascular • kidney • revascularization • stents

An extract of the first 250 words of the full text is provided, because this article has no abstract.

	Introduction

 
Major improvements in imaging, medical therapy, and techniques of renal revascularization have changed the landscape of renovascular disease during the past decade. This has been particularly true for atherosclerotic renal artery stenosis, which remains one of the most common conditions known to accelerate hypertension and one of the most common incidentally detected vascular lesions. Despite, or perhaps because of, these developments, few clinical questions provoke more controversy and debate among cardiologists, internists, and nephrologists than decisions about the optimal management of patients with main renal artery stenosis.

Even well-informed clinicians from different subspecialties hold widely divergent opinions about the role of renal revascularization, particularly for atherosclerotic disease. Studies of Medicare claims data indicate that application of peripheral intervention procedures varies >14-fold between various parts of the country.¹ Some of those from interventional subspecialties (primarily interventional radiology and cardiology) emphasize the major benefits now available from endovascular procedures, including the use of stents. They argue that revascularization offers the potential to improve or reverse renovascular hypertension, to salvage or preserve the renal circulation and renal function, and to improve the management of patients with refractory forms of congestive heart failure.² A recent review of the use of percutaneous renal artery procedures among Medicare beneficiaries confirms a rise from 7660 claims in 1996 to 18 520 claims in 2000, primarily because of a 2.8-fold increase in procedures by interventional cardiologists.³ Many in the nephrology community review the same published literature and reach nearly opposite conclusions. They argue that recent prospective studies fail . . . [Full Text of this Article]

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