A Literature Review of Renal Artery Stenosis: Presentation, Diagnosis, and Management Options in Secondary Hypertension.

Abstract

Renal artery stenosis (RAS) remains a critical and often underdiagnosed cause of secondary hypertension due to its insidious progression. This traditional review examines the epidemiology, various presentations of RAS, pathophysiology, and diagnostic modalities, with a focus on treatment options based on selected clinical trials. The prevalence of RAS is notably higher in individuals with systemic atherosclerotic conditions, making atherosclerosis the most common cause of RAS. Less frequently, fibromuscular dysplasia may be involved. Although RAS presents as hypertension in most cases, some people also present with acute syndromes like fluid overload in the lungs and renal insufficiency. Laboratory investigations, together with imaging modalities, help us diagnose RAS more accurately. Laboratory investigations also aid in confirming renal dysfunction and serologies to identify the underlying causes, such as vasculitis. Imaging modalities like digital subtraction angiography, computed tomography angiography, and magnetic resonance angiography have higher specificity and sensitivity in detecting the RAS. Although there is an ongoing debate regarding the management of RAS, medical management remains the first-line treatment for renovascular hypertension. Multiple randomized controlled trials have shown that combined revascularization and medical therapy may not significantly improve outcomes in the majority of cases. This literature review highlights the importance of individualized, evidence-based management of RAS.