A better understanding of atheromatous ischaemic renal vascular disease.

Atheromatous ischaemic renal vascular disease (AIRVD) comprises ischaemic r enal disease, atheromatous disease of the large arteries and intra-renal at heromatosis. Cholesterol emboli and lesions of nephroangiosclerosis are oft en associated, affecting the two kidneys. It is an increasingly common caus e of chronic renal failure in an aging population, affecting 12 to 14% of n ew patients requiring dialysis in the United States. Atheromatous stenoses are very progressive with a risk of renal atrophy; th ey are a marker of polyvascular disease, often detected during other angiog raphic investigation. Hypertension secondary to the stenosis, still incorre ctly called renovascular hypertension, is, however rare, affecting less tha n 0.5% of hypertensives. For economic reasons, it is important to select pa tients who need complementary investigation. In view of the absence of spec ific signs of the pathology, the "presumptive" diagnosis is based on a rang e of clinical and biological results, especially in a high risk context. Th e method of investigation varies from team to team, depending on the availa bility of equipment, the experience of the operators and the patient himsel f. Duplex Doppler, spiral angioscan and magnetic resonance angiography are the most pertinent investigations for the management of AIRVD. When the diagnosis of renal artery stenosis has been made, the problem of r evascularisation, the objective of which is to preserve or restore the func tional nephronic mass, has to be treated to prevent progression to end stag e renal failure. Although epidemiological and physiopathological evidence i s in favour of revascularisation, only renal salvage procedures are imperat ive. Apart from these indications, the clinical benefits of revascularisati on have not yet been demonstrated. In all cases, the control of associated risk factors is essential to maintain the success of revascularisation and slow down the progression of atheromatous disease.