Renal artery stenosis
Atherosclerotic renal artery stenosis and fibromuscular dysplasia, the clinical clues, duplex and CT angiography, why ASTRAL and CORAL ended routine stenting, and the few patients who still need revascularisation.
Tier 2Condition
Written with AI assistance and fact-checked against the sources below. For exam study, not clinical decisions. How notes are made
At a glance
- Renal artery stenosis (RAS) is atherosclerotic in about 90%, usually ostial and in older people with vascular disease. Fibromuscular dysplasia (FMD) causes most of the rest.
- It matters for three reasons: renovascular hypertension, ischaemic nephropathy (loss of GFR) and cardiac destabilisation (flash pulmonary oedema, unstable angina).
- Most atherosclerotic RAS is found by chance and needs medical therapy only: statin, antiplatelet, BP control and smoking cessation. ASTRAL and CORAL showed no benefit from routine stenting.
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Sources
- Guideline for the diagnosis and management of hypertension in adults 2016AU/NZNational Heart Foundation of Australia, 2016 (Heart Foundation hypertension page, updated October 2026, says a new guideline is pending)
- Therapeutic Guidelines: Kidney and UrinaryAU/NZTherapeutic Guidelines Ltd, 2026
- Mazzolai L et al. 2024 ESC Guidelines for the management of peripheral arterial and aortic diseases. Eur Heart J 2024;45:3538-3700European Society of Cardiology, 2024
- McEvoy JW et al. 2024 ESC Guidelines for the management of elevated blood pressure and hypertension. Eur Heart J 2024;45:3912-4018European Society of Cardiology, 2024
- Jones DW et al. 2025 AHA/ACC guideline for the prevention, detection, evaluation and management of high blood pressure in adults. Hypertension 2025;82:e212-e316American Heart Association / American College of Cardiology, 2025
- Bhalla V et al. Revascularization for renovascular disease: a scientific statement from the American Heart Association. Hypertension 2022;79:e128-e143American Heart Association, 2022
- ASTRAL Investigators. Revascularization versus medical therapy for renal-artery stenosis. N Engl J Med 2009;361:1953-62New England Journal of Medicine, 2009
- Cooper CJ et al. Stenting and medical therapy for atherosclerotic renal-artery stenosis (CORAL). N Engl J Med 2014;370:13-22New England Journal of Medicine, 2014
- Radermacher J et al. Use of Doppler ultrasonography to predict the outcome of therapy for renal-artery stenosis. N Engl J Med 2001;344:410-7New England Journal of Medicine, 2001
- Gornik HL et al. First international consensus on the diagnosis and management of fibromuscular dysplasia. Vasc Med 2019;24:164-89Vascular Medicine, 2019
- Last updated
- 14 November 2026
What changed
- 14 November 2026 Turnstile bot check on sign-in and signed-out feedback