Renal artery stenosis
Summary
Definition
History and exam
Key diagnostic factors
- presence of key risk factors
- onset of hypertension age >55 years
- history of accelerated, malignant, or resistant hypertension
- history of unexplained kidney dysfunction
- history of multi-vessel coronary artery disease
- history of other peripheral vascular disease
- abdominal bruit
- sudden or unexplained recurrent pulmonary oedema
- onset of hypertension age <30 years
Other diagnostic factors
- absence of family history of hypertension
- other bruits
- history of acute kidney injury after administration of ACE inhibitor or angiotensin II receptor antagonist
- history of unexplained congestive heart failure
- refractory angina
- history of hypokalaemia
Risk factors
- dyslipidaemia
- smoking
- diabetes
- female sex
Diagnostic investigations
1st investigations to order
- serum creatinine
- serum potassium
- urinalysis and sediment evaluation
- aldosterone-to-renin ratio
Investigations to consider
- duplex ultrasound
- gadolinium-enhanced MR angiography (MRA)
- CT angiography
- conventional angiography
- carbon dioxide (CO2) angiography
- non-contrast magnetic resonance angiography
- captopril radionuclide renal scan
Treatment algorithm
atherosclerotic RAS
fibromuscular dysplasia
Contributors
Authors
Mauricio Leitao, MD, MBA
Clinical Research Coordinator
University of Massachusetts Chan Medical School
UMass Memorial Medical Center
Worcester
MA
Declarações
ML declares that he has no competing interests.
Alvaro Alonso, MD, MSCR, FSVM
Associate Professor of Medicine
University of Massachusetts Chan Medical School
UMass Memorial Medical Center
Worcester
MA
Declarações
AA declares that he has no competing interests.
Agradecimentos
Dr Alvaro Alonso and Dr Mauricio Leitao would like to gratefully acknowledge Dr Rohit Malhotra, Dr Manmeet Singh and Dr Scott J. Gilbert, previous contributors to this topic. RM, MS and SJG declare that they have no competing interests.
Revisores
Robert Tompkins, MD
Associate Professor
Department of Family Medicine
University of Texas Health Science Center
Tyler
TX
Declarações
RT declares that he has no competing interests.
Irfan Moinuddin, MD
Assistant Professor
Chicago Medical School
Rosalind Franklin University
Lombard
IL
Declarações
IM declares that he has no competing interests.
John Webster, MD
Professor
Aberdeen Royal Infirmary
Foresterhill
Scotland
Declarações
JW declares that he has no competing interests.
Neil A. Kurtzman, MD
Grover E. Murray Professor
University Distinguished Professor
Texas Tech University Medical Center
Lubbock
TX
Declarações
NAK declares that he has no competing interests.
Créditos aos pareceristas
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Declarações
As afiliações e declarações dos pareceristas referem--se ao momento da revisão.
Referências
Principais artigos
Parikh SA, Shishehbor MH, Gray BH, et al. SCAI expert consensus statement for renal artery stenting appropriate use. Catheter Cardiovasc Interv. 2014 Dec 1;84(7):1163-71.Texto completo Resumo
Gornik HL, Persu A, Adlam D, et al. First International Consensus on the diagnosis and management of fibromuscular dysplasia. Vasc Med. 2019 Jan 16;24(2):164-89.Texto completo Resumo
Anderson JL, Halperin JL, Albert NM, et al. Management of patients with peripheral artery disease (compilation of 2005 and 2011 ACCF/AHA guideline recommendations): a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation. 2013 Apr 2;127(13):1425-43.Texto completo Resumo
Aboyans V, Ricco JB, Bartelink ME, et al. 2017 ESC guidelines on the diagnosis and treatment of peripheral arterial diseases, in collaboration with the European Society for Vascular Surgery (ESVS). Eur Heart J. 2018 Mar 1;39(9):763-816.Texto completo Resumo
Artigos de referência
Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.
Diagnósticos diferenciais
- Essential hypertension
- Acute kidney injury
- Renal artery dissection
Mais Diagnósticos diferenciaisDiretrizes
- ACR appropriateness criteria: renovascular hypertension
- 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines
Mais DiretrizesFolhetos informativos para os pacientes
High blood pressure: what is it?
High blood pressure: what are the treatment options?
Mais Folhetos informativos para os pacientes
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