Although the epidemic of childhood obesity in the developed world has resulted in more children being diagnosed with primary hypertension, renovascular disease remains an important consideration. The reason for investigation is to try and delineate if renovascular disease is present, as there is the potential to treat this group of patients. Those patients are usually identified by poor blood pressure control, despite the use of multiple anti-hypertensive medications or having known associated syndromes. Although advances in Doppler renal ultrasonography, computed tomography angiography (CTA) and magnetic resonance angiography (MRA) have occurred over the last decade, digital subtraction angiography remains the gold standard investigation, and offers a possible therapeutic intervention at the same time.