Renovascular disease is a cause of hypertension in 10 % to 15 % of prepubertal children. Interventions to address hypertension and causes of renovascular disease continue to advance. Successful interventions to treat renovascular disease include medical, angiographic, and surgical means, used alone or, more often, as combination therapy. Medical therapy is used to control the blood pressure prior to further intervention or in specific instances as long-term single therapy. Judicious use of percutaneous angioplasty and surgical intervention is usually successful in children with renal artery stenosis, although up to two-thirds of children will remain on antihypertensive medication after the procedure. Outcomes of combination therapy will continue to improve with advances in the use of antihypertensive medication in children, improvements in percutaneous angiography techniques, and progress in vascular surgical expertise.