Clinical practice. Renal-artery stenosis

N Engl J Med. 2009 Nov 12;361(20):1972-8. doi: 10.1056/NEJMcp0809200.


A 73-year-old former smoker with a history of hypertension and dyslipidemia presents to the emergency department with shortness of breath. His blood pressure is 160/75 mm Hg, heart rate 60 beats per minute, and respiratory rate 24 breaths per minute. Chest auscultation reveals diffuse rales, and there is 1+ pitting edema. The serum creatinine level is 1.4 mg per deciliter (124 µmol per liter) (estimated glomerular filtration rate, 52 ml per minute), and urinalysis shows 1+ protein. His condition improves after treatment with intravenous diuretics, but his systolic blood pressure remains elevated, at 170 mm Hg. Magnetic resonance angiography (MRA) reveals a diseased aorta, a high-grade ostial lesion of the left renal artery that is consistent with atherosclerotic stenosis, and a normal right renal artery. How should he be further evaluated and treated?

Publication types

  • Review

MeSH terms

  • Aged
  • Angioplasty, Balloon
  • Angiotensin-Converting Enzyme Inhibitors / therapeutic use
  • Antihypertensive Agents / therapeutic use
  • Humans
  • Hypertension / etiology
  • Magnetic Resonance Angiography
  • Male
  • Practice Guidelines as Topic
  • Renal Artery Obstruction / complications
  • Renal Artery Obstruction / diagnosis*
  • Renal Artery Obstruction / therapy*
  • Ultrasonography, Doppler, Color


  • Angiotensin-Converting Enzyme Inhibitors
  • Antihypertensive Agents