In patients with atherosclerotic disease, measures should be taken to limit the progression of plaque formation, including smoking cessation and administration of statins.

The indications for renal revascularization are controversial, particularly for patients with satisfactory blood pressure control and stable kidney function. In general, interventions should be considered in patients who have drug-resistant or malignant hypertension. In addition, intervention should be considered in patients who have either bilateral stenosis or stenosis to a solitary kidney along with normal or mildly impaired renal function and no evidence of intrinsic renal disease. Although it is difficult to predict which patients with renal dysfunction will benefit the most from revascularization, some evidence suggests that patients with high resistance indices on ultrasound are unlikely to regain much function because they are more likely to have chronic, irreversible renal disease.

Endovascular repair is generally the preferred method of intervention. It consists of balloon angioplasty and, in patients with atherosclerosis, stent placement. Surgical bypass of the renal artery may be indicated in patients with complex lesions.