Causes of renal artery stenosis Atherosclerosis is the most common cause of renal artery stenosis, accounting for more than 70% of the cases in China, followed by aortitis (about 20%) and fibromuscular dysplasia (about 5%). Renal artery stenosis is an important cause of hypertension and/or renal insufficiency, with a prevalence of about 1-3% of the hypertensive population. In particular, aortic and renal artery stenosis due to aortitis is an important cause of secondary vasogenic hypertension in our young people. Diagnosis of renal artery stenosis Clinical clues of renal artery stenosis: (1) malignant or intractable hypertension; (2) previously well-controlled hypertension becoming poorly controlled; (3) hypertension with abdominal vascular murmur; (4) hypertension combined with evidence of other atherosclerosis, such as coronary artery disease, carotid vascular murmur, and peripheral vascular disease; (5) elevated serum creatinine that can’t be explained by any other reason; (6) very large reduction of blood pressure by ACEI or ARB. (6) ACEI or ARB with very high blood pressure lowering or induced acute renal insufficiency; (7) Episodic pulmonary edema with mismatch of left heart function; (8) Hypertension with asymmetry in the size of both kidneys. Anatomical (Doppler ultrasound, magnetic resonance angiography, computed tomography angiography) and functional diagnosis of renal artery stenosis (openbeat renography, split-renal glomerular filtration rate, and split-renal venous renin activity) are selected according to clinical need. Transarterial angiography remains the gold standard for the diagnosis of renal artery stenosis. Treatment of renal artery stenosis Renal artery revascularization, especially percutaneous stenting, is the treatment of choice for renal vascular hypertension. For one-sided renal artery stenosis in which renal function can still be maintained in the normal range, ACEI or ARB can be used, and renal volume and subrenal function should be measured regularly during the maintenance treatment phase, and hemodialysis should be reconstructed if the affected kidney shows a tendency to atrophy or if renal function decreases significantly. Renal artery stenosis in bilateral or unifunctional kidneys is poorly treated with medication alone, and hemodialysis is recommended. Renal vascular hypertension due to aortitis and fibromuscular dysplasia is associated with a high success rate of percutaneous arterioplasty and a high mid- to long-term clinical benefit. CCBs and β-blockers are used in patients in whom ACEIs or ARBs are contraindicated, and α-blockers, nonspecific vasodilators, and central antihypertensive agents may also be used in combination.