Review: Renovascular disease in diabetic patients

Atherosclerotic renovascular disease (ARVD) is a common condition which presents with acute or chronic renal failure, hypertension or cardiac failure. Its prevalence is high in the elderly and in those with evidence of generalised vascular disease. It is therefore common in diabetic patients, who are prone to development of generalised atherosclerotic vascular disease. The majority of diabetic patients have clinical indications that merit angiotensin-converting enzyme (ACE) inhibitor or angiotensin II receptor antagonist (AIIA) therapy, but even if ARVD is present, acute renal dysfunction will be the exception rather than the rule. Certain clinical clues should instigate a high index of suspicion for the presence of ARVD in the diabetic patient, but it does not follow that detection of anatomically significant stenoses within the renal arteries should automatically be treated by renal revascularisation. The results of Angioplasty and Stent for Renal Artery Lesions (ASTRAL), a UK multi-centre study, should hopefully guide appropriate practice in this area in the future.