Would you pursue renal artery revascularization in a patient with bilateral renal artery stenosis, stable CKD stage 3A, blood pressure well controlled on two medications, and no episodes of acute pulmonary edema but with decreasing kidney size by 1 cm over two years?

If the renal artery stenosis is due to atherosclerotic disease, I would make sure to optimize atherosclerotic risk factors first, which would have systemic benefit. That includes stopping smoking, aggressively lowering lipids with attention to high-density lipoprotein (HDL)/low-density lipoprotein (...