With the availability of ultrasonic duplex scanning we now have a method of safely screening those patients who may be thought to have renal artery stenosis as the basis for hypertension or renal failure. Modern instrumentation combined with an experienced technologist makes this a reasonable and accurate screening test. One of its major advantages is that it can be used for repeat studies to document the outcome of any form of intervention designed to remove or bypass areas of stenosis. We no longer need to wonder if a reconstruction has been successful or not. Another great advantage is its role in documenting both the degree of narrowing and its effect on kidney size. It is now known, because of information obtained with this technology, that high-grade renal artery stenoses are accompanied by a decrease in kidney size. It is also possible to document disease progression with atherosclerotic involvement of the renal arteries. With more widespread use of this method, we will be able to obtain useful information on how renal artery disease should be treated and monitored.