Renal artery stenosis is an increasingly encountered and significant cause of hypertension. Atherosclerotic renovascular disease accounts for the vast majority of patients with ≈90% versus 10% of cases due to fibromuscular dysplasia and other more rare causes. The diagnostic landscape and management of each of these conditions have evolved significantly in the last few decades. Despite international registries, randomised controlled trials and observational studies, uncertainty remains and consensus guidelines have been created to support decision-making. In this chapter, we provide a practical overview of the epidemiology, diagnosis and treatment decision aids, along with directions for future research.