[Logical basis for the diagnosis of renovascular hypertension. Application to the treatment of atheromatous stenosis of the renal arteries].

The diagnosis of atheromatous stenosis of the renal arteries has been greatly facilitated by the advances achieved in medical imaging: intravenous digital angiography, in particular, enables the renal arteries to be visualized in patients with progressive hypertension refractory to treatment and associated with renal impairment or symptomatic atheroma. However, the diagnosis of hypertension with renal stenosis is not synonymous with renovascular hypertension, the latter term being reserved to a disease that can be cured by a causal treatment. The diagnosis of imputation, inspired by experimental models, rests on exploration of the renal endocrine and excretory function upstream of the stenosis before and after blockade of the renin-angiotensin system by angiotensin-converting enzyme enzyme inhibitors. The exploration is made by urography, measurements of renin concentrations in the two renal veins and radioisotope scanning. The decision to operate or not is taken after comparing these renal data with such vascular data as influence of hypertension on the target organs and diffusion of the atheromatous disease to other territories. Treatment may be purely medical, but in most cases it includes a revascularization procedure, starting with transluminal dilatation: surgical revascularization is used only in difficult cases, in complete arterial obliteration and in failures of dilatation. Revascularization is not indicated when the stenosis has no systemic or local functional repercussions before or after blockade of the renin-angiotensin system.