Renal failure in atherosclerotic renovascular disease: pathogenesis, diagnosis, and intervention.

Atherosclerotic renovascular disease (ARVD) is increasingly recognised as an important cause of both chronic and end stage renal failure. These patients tend to do badly on dialysis, which reflects their systemic atherosclerotic burden. In an eVort to delay and perhaps prevent their need for renal replacement therapy, some patients are subjected to a variety of medical, radiological and surgical interventions, although evidence for each is sparse. The purpose of this review is to describe the epidemiology and pathophysiology of renal failure in ARVD, discuss the available diagnostic techniques, consider the evidence for benefit from intervention in the context of pathogenesis and finally, identify those gaps in our knowledge which impede the practice of evidence based medicine.