Renal artery stenosis classification

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief: Shivam Singla, M.D.[2]


Renal artery stenosis classification is doner with the help of a doppler scanning of the renal artery.


According to the American heart associated AHA classification, the renal artery stenosis is divided into grade I, II, III depending upon the Hypertension/Normotension and Renal function. According to AHA[1]

Grade 1- Renal artery stenosis is present but the patient is Normotensive with a normal renal function.

Grade 2- Renal artery stenosis is present but the patient is having hypertension that is medically controlled with a normal renal function.

Grade 3- Renal artery stenosis is present but the patient is having hypertension or volume overloaded with abnormal renal function.

Renal artery stenosis may be classified according to whether there is unilateral or bilateral involvement of the renal arteries. Additionally, renal artery stenosis is often classified anatomically according to severity of luminal narrowing. The following criteria are used according to most published studies about atherosclerosis renal artery stenosis.[2][3]

Severity Luminal Narrowing
Normal 0%
Mild 1-49%
Moderate 50-69%
Severe 70-99%
Occluded 100%

To note, some studies have different classification criteria than those listed above, with "mild disease" starting after 50% of luminal narrowing. Such classification remains coherent with the definition of atherosclerotic renal artery stenosis as narrowing > 50%.[4]

Another classification is based on hemodynamic function in renal artery stenosis. This classification simply differentiates between hemodynamically insignificant renal artery stenosis (< 75% stenosis) and hemodynamically significant renal artery stenosis (> 75% stenosis).[5]


  1. "Renal Artery Stenosis Guidelines: Guidelines Summary".
  2. Kliewer MA, Tupler RH, Carroll BA, Paine SS, Kriegshauser JS, Hertzberg BS; et al. (1993). "Renal artery stenosis: analysis of Doppler waveform parameters and tardus-parvus pattern". Radiology. 189 (3): 779–87. doi:10.1148/radiology.189.3.8234704. PMID 8234704.
  3. Desberg AL, Paushter DM, Lammert GK, Hale JC, Troy RB, Novick AC; et al. (1990). "Renal artery stenosis: evaluation with color Doppler flow imaging". Radiology. 177 (3): 749–53. doi:10.1148/radiology.177.3.2243982. PMID 2243982.
  4. Lao D, Parasher PS, Cho KC, Yeghiazarians Y (2011). "Atherosclerotic renal artery stenosis--diagnosis and treatment". Mayo Clin Proc. 86 (7): 649–57. doi:10.4065/mcp.2011.0181. PMC 3127560. PMID 21719621.
  5. Kidney Disease Outcomes Quality Initiative (K/DOQI) (2004). "K/DOQI clinical practice guidelines on hypertension and antihypertensive agents in chronic kidney disease". Am J Kidney Dis. 43 (5 Suppl 1): S1–290. PMID 15114537.