Table 1.

Factors favoring medical therapy with or without renal revascularization for atherosclerotic renal artery stenosis

Factors favoring medical therapy plus revascularization for renal artery stenosis
 Progressive decline in GFR during treatment of hypertension
 Failure to achieve adequate BP control with optimal medical therapy
 Rapid or recurrent decline in GFR in association with a reduction in systemic pressure
 Decline in GFR during therapy with ACE inhibitors or ARBs
 Recurrent congestive heart failure in a patient in whom left ventricular failure does not explain the cause (flash pulmonary edema)
Factors favoring medical therapy and surveillance of renal artery disease
 Controlled BP with stable renal function
 Stable renal artery stenosis without progression on surveillance studies (e.g., serial duplex ultrasound)
 Advanced age and/or limited life expectancy
 Extensive comorbidities that make revascularization too risky
 High risk for or previous experience with atheroembolic disease
 Other concomitant renal parenchymal diseases that cause progressive renal dysfunction (e.g., diabetic nephropathy) or severely reduced kidney size (<7 cm)
  • ACE, angiotensin-converting enzyme; ARB, angiotensin receptor blocker.