Renal artery stenosis generally has an insidious onset and a tendency to worsen gradually, and once symptoms appear they are often already at an advanced stage, so it is important to make a definitive diagnosis before irreversible renal impairment occurs. Since there is no difference in clinical symptoms between hypertension caused by renal artery stenosis and primary hypertension, the diagnosis mainly relies on a high degree of vigilance. Therefore, when some clinical clues are found, the possibility of this disease should be thought of in time, and the occurrence of the following situations may suggest the presence of RAS. 1, the following types of hypertension manifestations: (1) hypertension before the age of 30 years, or after the age of 55 years of age, severe hypertension; (2) acute hypertension (previously controllable hypertension suddenly and persistently worsened); (3) recalcitrant hypertension (when the combination of a sufficient amount of 3 antihypertensive drugs, including diuretics, it is still difficult to achieve the target blood pressure); (4) malignant hypertension (hypertension combined with acute target organ damage, such as acute renal failure, acute heart failure, or new-onset optic nerve or other cerebral neuropathy and retinopathy III~IV); 2. When the application of angiotensin-converting enzyme inhibitor (ACEI) or angiotensin receptor antagonist (ACEI) or angiotensin receptor antagonist (ACEI) or angiotensin receptor antagonist (ACEI) is applied to the blood pressure of the patient, the blood pressure is not controlled by the patient’s blood pressure. Antagonist (ARB) drugs appear new-onset azotemia or deterioration of renal function (blood creatinine increased by more than 50%), or the elderly appear not easily explained renal hypoplasia; 3, the existence of difficult to explain renal atrophy; 4, the sudden appearance of pulmonary edema; 5, abdominal vascular murmur can be heard; 6, ultrasound and other tests found that the size of the two kidneys is obviously asymmetric; 7, accompanied by other vascular diseases, such as coronary heart disease, Carotid artery stenosis or lower limb artery stenosis. What are the clinical manifestations of renal artery stenosis? 1, renal vascular hypertension Renal artery stenosis patients mostly do not have a family history of hypertension, which is characterized by rapid progression of hypertension, and blood pressure is not easy to control. Diastolic blood pressure increases significantly (often more than 110-120 mmHg), which can be manifested as malignant hypertension (rapid increase in blood pressure, diastolic blood pressure is persistently greater than 130 mmHg, and headache, blurred vision, fundus hemorrhage, oozing, and papilledema, and even sudden blindness, epileptic seizures, persistent proteinuria, hematuria and tubulointerstitial urine). 2.Abdominal and lumbar murmurs About 50% of patients can hear systolic murmurs at 2~7cm above the umbilicus and 2.5cm to the left and right. 3.Primary manifestations caused by atherosclerosis or aortitis, there are often primary manifestations, the former mostly occurs in the elderly, can appear stroke, coronary heart disease, peripheral arteriosclerosis and fundus changes; the latter are mostly young women, can appear fever, arthralgia, pulseless and other manifestations. 4.Other Some patients have hyperaldosteronism (leading to hypokalemia), mild urinary abnormalities, impaired renal function (ischemic nephropathy).