- To review current state of knowledge in physiopathological and clinical aspects of renovascular hypertension (RVh) and its treatment. - To discuss the best imaging technique to evaluate patients with suspicion of RVh.

PHYSIOPATHOLOGY Renovascular hypertension is produced by decreasing caliber of one or more renal arteries, which leads to an ischemia stimulating the juxtaglomerular apparatus. In the long term, sustained ischemia produces a progressive size reduction with subsequent renal atrophy. InTable 1 sumarizes themain physiopathological elements. Often, the unilateral atherosclerotic stenosis coexists with some degree of renal insufficiency nonischemic condition. The insufficieny renal conditions the choice of imaging techniques. Native kidneys: Atherosclerosis (80-90%): more common in men older than 55 years, smokers with atherosclerotic lesions in other...

IMAGING TECHNIQUES Different imaging techniques currently available in patients with suspected renal artery stenosis have a highly diagnostic efficiency. The main factors in the choice of technique is determined by the degree of impairment of renal function, available technology, the operators experience and the ability to work in a coordinated way with the clinician / nephrologist. 1. US-Doppler Color: Duplex Color Doppler Ultrasound technique is commonly used as first line, and should be assessed: ✦ Grey scale: the absence of alterations in mode B does...

- Physiopathological knowledge and clinical aspects ofrenovascular hipertensionand its treatment are essential to supply suitable radiological information. - Doppler ultrasound is a good screening technique and sometimes may be diagnostic. MDCT and contrast MR angiography have a high accuracy in RAS but have limitations in patients with low glomerular filtration rate. Currently, non -contrast MR angiography plays an essential role in these patients.

1. Textor SC, Lerman L. Renovascular hypertension and ischemic nephropathy. Am J Hypertens 2010;23(11):1159-69. 2. Plouin PF, Bax L. Diagnosis and treatment of renal artery stenosis. Nat Rev Nephrol 2010;6(3):151-9. 3. Olin JW, Sealove BA. Diagnosis, management, and future developments of fibromuscular dysplasia. J Vasc Surg 2011;53(3):826-36.e1. 4. Kobayashi K, Censullo ML, Rossman LL, Kyriakides PN, Kahan BD, Cohen AM. Interventional radiologic management of renal transplant dysfunction: indications, limitations, and technical considerations. Radiographics 2007;27(4):1109-30. 5. Rocha-Singh KJ, Eisenhauer AC, Textor SC, Cooper CJ, Tan WA,...