The Role of the Renin-Angiotensin-Aldosterone System in Renal Artery Stenosis, Renovascular Hypertension, and Ischemic Nephropathy: Diagnostic Implications

The renin-angiotensin-aldosterone system (RAAS) has an impressive pathophysiology and numerous systemic correlations, as it is a major regulatory system of vascular and renal function. RAAS represents an important player in the pathogenesis of renal artery stenosis (RAS) and ischemic nephropathy. The activation of the RAAS and sympathetic overactivity are highly responsible for the cardiovascular and renal morbidity in RAS patients. The evaluation of the RAAS activity remains an unsolved issue in the clinical assessment of RAS/ischemic nephropathy with important therapeutic consequences. Selection of patients with RAS for revascularization procedures is based on the benefit in terms of renal function improvement/stabilization and improvement of BP control. Unfortunately, this issue still remains a major challenge for nephrologists. © 2009 Elsevier Inc. All rights reserved.