Is It Bilateral Renal Artery Stenosis?

The people with bilateral renal arteries stenosis are extremely high risk. They're at a pretty significant risk of their kidneys going on to fail no matter what you're doing because that's kind of rapidly declining. The paradox here for me and Paul I don't know if that you noticed this too like we're always taught like okay if you start an aceran arb and they're creatinine bumps more than 30% they might have bilateral renal artery stenosis. But it sounds like the medical therapy is still you you still have to treat them try to treat them medically, so how do you reconcile those things?