Renal artery stenosis (RAS) was searched for in a Type 2 diabetes population (n =208) with severe hypertension (SHT) and/or renal deficiency (RD) and/or severe macroangiopathy (MA), using arteriography and/or duplex colour scan (with confirmation by arteriography or magnetic resonance angiography). Thirty-four (16.3 %) cases had significant RAS >=70% (83% unilateral, 17% bilateral; 11.7% with total thrombosis). High significance (P<0.01) (34 RAS vs 174 subjects without RAS) was found for male predominance (sex ratio 0.8), smoking (47%), insulin requirement (65%), prevalence and severity of decreased renal function (65%), severe hypertension (53%), and prevalence of macroangiopathy (82%), especially in association with coronary heart disease (65%). RAS prevalence was low in subjects with only 1 (8%) diagnostic criterion and high when 2 (21%) or 3 (41%) signs were present, regardless of the criterion (HT/RD/MA). A high increase of RAS prevalence was found in males, smokers and patients with heart disease or macroalbuminuria when 2 or 3 diagnostic criteria were present (no increased prevalence for only 1 criterion). RAS screening should be performed in a Type 2 diabetic population with HT, RD, or MA by opacification of the renal arteries at the same time as arteriography for control of another vessel, or by duplex colour scan when 2 or 3 diagnostic criteria are present. This attitude allows a diagnostic score of 85 % of RAS in this Type 2 diabetic population.