Table 8 |.

Gaps in knowledge and research recommendations for renovascular disease and CKD

• Gain a better understanding of the pathogenesis and time course of ischemia and renal parenchymal injury in atherosclerotic renal artery stenosis

• Develop specific techniques for assessment of the physiologic relevance of renal artery stenosis (such as are those currently available for coronary artery stenoses)

• Determine optimal techniques to confirm kidney viability and non-viability prior to consideration of revascularization

• Determine the benefit of revascularization therapy in patients with renal artery stenosis and acute decompensated and progressive chronic heart failure

• Determine long-term outcomes after renal revascularization therapy. Is preventing kidney atrophy important regardless of clinical presentation?

• Further explore the relationship of proteinuria to outcomes after revascularization in atherosclerotic renal artery stenosis

• An RCT of medical therapy versus revascularization plus medical therapy is warranted for patients with renal artery stenosis and high-risk clinical presentations (Table 7)

• Encourage trials of novel therapies (e.g., stem cells, VEGF, endothelin inhibitors) in human ARVD

ARVD, atherosclerotic renovascular disease; CKD, chronic kidney disease; RCT, randomized controlled trial; VEGF, vascular endothelial growth factor.