A series of 68 renal arteriograms for hypertension is reviewed with reference to the roentgenologic indications of renal artery disease on the intravenous pyelogram. Of the 68 cases, 29 had renal artery lesions, 21 unilateral and 8 bilateral. Of the 21 unilateral lesions, 19 occurred in the main renal artery and 2 in a major branch. Asymmetry of length alone without parenchymatous thinning was not found to have any significant association with renal artery disease and is considered a normal anatomic variant. Asymmetry of length of 1.0 cm. or more with parenchymatous thinning, whether or not accompanied by evidence of diminished function on the affected side, was found to be very good evidence of a renal artery lesion, unilateral or bilateral, and a strong indication for renal arteriography. Impaired function (diminished volume and concentration) on the intravenous pyelogram without significant anatomic asymmetry of the kidneys was found to be a less reliable indication of renal artery lesion, but was, nevertheless, an indication for renal arteriography. Despite the frequency of its occurrence in some reported series, hyperconcentration of opaque medium in an affected kidney was not found in this series. Although delay on the 4 min. intravenous pyelogram was seen not infrequently in unilateral and bilateral renal artery lesions, it was present only when accompanied by other evidence of renal artery disease and did not contribute greatly to the accuracy of diagnosis from intravenous pyelography. No rapid sequence intravenous pyelographies, however, were performed.