Of 617 hypertensive patients selected for renal angiography at the Cleveland Clinic, 173 were found to have occlusive disease of one or both renal arteries. Surgical treatment was performed in 126, with relief of hypertension in about 62% of these patients. In recent years the majority of patients have had vascular reconstructive procedures with salvage of renal function. The important diagnostic tests in discovering those hypertensive patients who had renal artery occlusive disease were the intravenous urogram and renal angiography; 6 diagnostic signs revealed by urography were recognized and a simple, safe, effective method of renal angiography by translumbar aortography was used in all cases. Six distinct pathologic groups of occlusive lesions were found in the renal arteries, and these are correlated with their corresponding angiographic findings.