Atherosclerotic renal artery stenosis is a very common lesion manifesting a variety of clinical syndromes such as hypertension and ischemic nephropathy. The main treatment for this group of patients is endovascular revascularization of the renal arteries. The recent randomized trials reduced the enthusiasm for revascularization of renal artery stenosis in general, but many clinicians recognize the need for renal artery stenting in appropriately selected patients. This article highlights the main causes of stenoses and occlusions of the renal arteries, renal compensatory opportunities that arise in response to a decrease in blood flow? And describes the recent randomized trials in this area. Also in the article shows the role of evaluating the viability of kidney and compensatory possibilities in the selection of patient groups, which need the endovascular revascularization.