Atherosclerotic renal arterial stenosis (ARAS) is a common complication in elderly patients with chronic kidney disease (CKD). It has been reported that 5-22% of elderly CKD patients are affected by ARAS [1]. ARAS often causes severe renovascular hypertension that is difficult to treat with antihy-pertensive combination regimens. As angiotensin is generally recognized to be responsible for renovascular hypertension, a recent report has suggested that treatment with angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARB) is beneficial for RAS patients by leading to lower cardiovascular event rates and reducing the requirement for dialysis [2]. However, these benefits come with considerable risk for hospitalization for rapidly progressive renal dysfunction in some ARAS population by excessive reduction of glomerular filtration pressure [2, 3]. Moreover, ARAS is associated with a high annual death rate of 16%, mainly due to cardiovascular events [4], and is a predictor for death independent of other conventional cardiovascular risk factors [5, 6].
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