Summary
Definition
History and exam
Key diagnostic factors
- presence of key risk factors
- onset of hypertension (HTN) age >55 years
- history of accelerated, malignant, or resistant HTN
- 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 HTN age <30 years
Other diagnostic factors
- absence of family history of HTN
- 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
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
Contributors
Authors VIEW ALL
University of Massachusetts Medical School
UMass Memorial Medical Center
Worcester
MA
Disclosures
RM declares that he has no competing interests.
Assistant Professor of Medicine
University of Massachusetts Medical School
UMass Memorial Medical Center
Worcester
MA
Disclosures
AA declares that he has no competing interests.
RM and AA would like to gratefully acknowledge Dr Manmeet Singh and Dr Scott J. Gilbert, previous contributors to this monograph. MS and SJG declare that they have no competing interests.
Peer reviewers VIEW ALL
Associate Professor
Department of Family Medicine
University of Texas Health Science Center
Tyler
TX
Disclosures
RT declares that he has no competing interests.
Assistant Professor
Chicago Medical School
Rosalind Franklin University
Lombard
IL
Disclosures
IM declares that he has no competing interests.
Professor
Aberdeen Royal Infirmary
Foresterhill
Scotland
Disclosures
JW declares that he has no competing interests.
Grover E. Murray Professor
University Distinguished Professor
Texas Tech University Medical Center
Lubbock
TX
Disclosures
NAK declares that he has no competing interests.
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