Renovascular hypertension is one of the most common forms of secondary hypertension. Over 95% of cases of renovascular hypertension are due either to atherosclerosis of the main renal artery trunks or to fibromuscular dysplasia. These two causes of renal artery stenosis have been extensively discussed in recent reviews and consensus. The aim of the current article is to provide comprehensive and up-to-date information on the remaining causes. While these causes are rare or extremely rare, etiologic and differential diagnosis matters both for prognosis and management. Therefore, the clinician cannot ignore them. For didactic reasons, we have grouped these different entities into stenotic lesions (neurofibromatosis type 1 and other rare syndromes, dissection, arteritis, and segmental arterial mediolysis) often associated with aortic coarctation and other arterial abnormalities, and nonstenotic lesions, where hypertension is secondary to compression of adjacent arteries and changes in arterial pulsatility (aneurysm) or to the formation of a shunt, leading to kidney ischemia (arteriovenous fistula). Finally, thrombotic disorders of the renal artery may also be responsible for renovascular hypertension. Although thrombotic/embolic lesions do not represent primary vessel wall disease, they are characterized by frequent macrovascular involvement. In this review, we illustrate the most characteristic aspects of these different entities responsible for renovascular hypertension and discuss their prevalence, pathophysiology, clinical presentation, management, and prognosis.

中文翻译：

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除了动脉粥样硬化和纤维肌发育不良：肾血管性高血压的罕见原因

肾血管性高血压是继发性高血压最常见的形式之一。超过 95% 的肾血管性高血压病例是由于主要肾动脉干的动脉粥样硬化或纤维肌性发育不良所致。肾动脉狭窄的这两个原因在最近的评论和共识中得到了广泛的讨论。本文的目的是提供有关其余原因的全面且最新的信息。虽然这些原因很少或极其罕见，但病因学和鉴别诊断对于预后和治疗都很重要。因此，临床医生不能忽视它们。出于教学原因，我们将这些不同的实体分为狭窄病变（1 型神经纤维瘤病和其他罕见综合征、夹层、动脉炎和节段性动脉中间溶解），通常与主动脉缩窄和其他动脉异常相关，以及非狭窄病变，其中高血压继发于邻近动脉受压，动脉搏动发生变化（动脉瘤）或形成分流，导致肾脏缺血（动静脉瘘）。最后，肾动脉血栓性疾病也可能是肾血管性高血压的原因。尽管血栓/栓塞病变并不代表原发性血管壁疾病，但其特征是频繁的大血管受累。在这篇综述中，我们阐述了导致肾血管性高血压的这些不同实体的最具特征性的方面，并讨论了它们的患病率、病理生理学、临床表现、治疗和预后。