Renal artery stenosis caused by renal vascular hypertension is secondary hypertension, renal artery stenosis of the main clinical manifestations of renal vascular hypertension and ischemic nephropathy, in patients with intractable hypertension confirmed by angiography with renal artery stenosis and the implementation of interventional therapy so that the blood pressure is controlled accounted for 64%, but also to stabilize the renal function of 79% of patients with renal artery stenosis. Renal artery stenosis CTA manifestations What are the consequences of untreated renal artery stenosis? Renal artery stenosis can lead to renal vascular hypertension, renal atrophy, end-stage renal disease and so on. Therefore, we need to enhance our understanding of the disease, early diagnosis and active intervention to protect or restore patients’ renal function and improve the prognosis. The main causes of renal artery stenosis are atherosclerotic renal artery stenosis, myofibrillar dysplasia and aortitis. The latter two diseases are most common in young patients, and atherosclerosis is predominant in middle-aged and elderly patients. Renal artery stenosis is suspected when the patient has the following manifestations: 1. Hypertension before the age of 30 years or severe hypertension after the age of 55 years. 2, Recent sudden persistent malignant hypertension. 3, Combined application of three or more antihypertensive drugs, including diuretics, still poorly controlled intractable hypertension. 4.Existence of unexplained renal atrophy or unequal sizes of both kidneys (diameter difference of more than 1.5 cm). 5, Unexplained renal insufficiency and ischemic nephropathy in the elderly. When renal artery stenosis occurs, the following symptoms mainly appear. 1, renal vascular hypertension Most patients with renal artery stenosis do not have a family history of hypertension, and it is characterized by rapid progression of hypertension, and the blood pressure is not easy to control. The increase of diastolic blood pressure is obvious (often more than 110-120mmHg), and it can be manifested as malignant hypertension (blood pressure rises sharply, and the diastolic blood pressure is persistently greater than 130mmHg,). Some patients have hyperaldosteronism (leading to hypokalemia), mild urinary abnormalities, and impaired renal function (ischemic nephropathy). 3.Primary manifestations Those caused by atherosclerosis mostly occur in the elderly, and may have stroke, coronary heart disease, peripheral arteriosclerosis and fundus changes; those caused by aortitis, mostly young women, may have fever, arthralgia, pulselessness and other manifestations. Adjunctive tests mainly use noninvasive tests such as renal B-mode ultrasound, color Doppler ultrasound of renal vessels, computed tomography angiography (CTA) magnetic resonance angiography (MRA). Angiography is considered the “gold standard” for the diagnosis of RAS, but is generally not used alone for the diagnosis of renal artery stenosis and is usually performed in conjunction with endovascular treatment of renal artery stenosis. The main goals of treatment for RAS are to control hypertension to prevent complications of hypertension, and to correct severe RAS to prevent renal decompensation or to restore or improve impaired renal function. For renal artery stenosis, the treatment includes medication, surgery and intervention: 1. Medication: it cannot improve the ischemia of the affected kidney and only helps to control hypertension. The application of drugs to control blood pressure is still the basis of treatment for renal artery stenosis. By controlling blood pressure or alleviating the deterioration of renal function, certain efficacy is achieved in most patients. It is suitable for patients with less than 50% stenosis, mild clinical symptoms, those who may be ineffective or too risky for hemodialysis, and auxiliary treatment after hemodialysis. 2.Interventional therapy: characterized by small trauma, precise efficacy and low complications. It should be the first choice of treatment. Interventional therapy includes percutaneous transluminal renal arterioplasty and renal artery stenting. Mainly through the femoral artery puncture, the catheter with a balloon is inserted into the narrowed renal artery, and then the balloon is inflated, and the narrowed renal artery is expanded from the inside to the normal caliber, which is especially suitable for patients with fibromuscular dysplasia. Because patients with atherosclerosis and aortitis are prone to restenosis after dilatation, these patients can be placed on a stent after dilatation to prevent postoperative stenosis. Interventional therapy has the advantages of less trauma, greater safety, and faster recovery, and is now widely used around the world as the treatment of choice for renal artery stenosis. Renal artery stenosis imaging renal artery stenosis disappeared after implantation of stent 3, surgical treatment: mainly including abdominal aorta – renal artery bypass, renal artery endarterectomy, renal artery stenosis resection of the segment of the anastomosis, own kidney transplantation so that the diseased kidney to obtain blood supply, can not be carried out the above treatment can be considered to excise the diseased kidney. The disadvantage of the surgical method is that it is more traumatic, but the therapeutic effect is very reliable, and it can also be used to treat patients who are not suitable for percutaneous transluminal renal arterioplasty. Because of the mature use of interventional techniques, the use of surgical treatment is now gradually decreasing. The development of a treatment plan for each patient must be based on a comprehensive evaluation of the patient’s specific condition, age, economic status and the corresponding risks to develop an individualized treatment strategy. In conclusion, drug therapy is the cornerstone of other therapeutic means, and renal artery intervention on the basis of drug therapy, with the advantages of high success rate, low trauma and high surgical safety, has become the first choice of treatment. Although surgical renal artery revascularization has shortcomings, it is still an irreplaceable treatment for some special patients.