Resumen
Definición
Anamnesis y examen
Principales factores de diagnóstico
- presença dos principais fatores de risco
- início da hipertensão com >55 anos
- história de hipertensão acelerada, maligna ou resistente
- história de disfunção renal inexplicada
- história de doença arterial coronariana multivasos
- história de doença vascular periférica
- sopro abdominal
- edema pulmonar recorrente súbito ou inexplicado
- início da hipertensão com <30 anos
Otros factores de diagnóstico
- ausência de história familiar de hipertensão
- outros sopros
- história de lesão renal aguda após a administração do inibidor da enzima conversora da angiotensina (IECA) ou antagonista do receptor de angiotensina II
- história de insuficiência cardíaca congestiva inexplicada
- angina refratária
- história de hipocalemia
Factores de riesgo
- dislipidemia
- tabagismo
- diabetes
- sexo feminino
Pruebas diagnósticas
Primeras pruebas diagnósticas para solicitar
- creatinina sérica
- potássio sérico
- urinálise e avaliação do sedimento
- razão aldosterona/renina
Pruebas diagnósticas que deben considerarse
- ultrassonografia duplex
- angiografia por ressonância magnética (ARM) contrastada por gadolínio
- Angiotomografia
- angiografia convencional
- angiografia de dióxido de carbono (CO2)
- angiografia por ressonância magnética sem contraste
- cintilografia renal com radionuclídeo e captopril
Algoritmo de tratamiento
estenose da artéria renal (EAR) aterosclerótica
displasia fibromuscular
Colaboradores
Autores
Mauricio Leitao, MD, MBA
Clinical Research Coordinator
University of Massachusetts Chan Medical School
UMass Memorial Medical Center
Worcester
MA
Divulgaciones
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
Divulgaciones
AA declares that he has no competing interests.
Agradecimientos
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.
Peer reviewers
Robert Tompkins, MD
Associate Professor
Department of Family Medicine
University of Texas Health Science Center
Tyler
TX
Disclosures
RT declares that he has no competing interests.
Irfan Moinuddin, MD
Assistant Professor
Chicago Medical School
Rosalind Franklin University
Lombard
IL
Disclosures
IM declares that he has no competing interests.
John Webster, MD
Professor
Aberdeen Royal Infirmary
Foresterhill
Scotland
Disclosures
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
Disclosures
NAK declares that he has no competing interests.
References
Key articles
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.Full text Abstract
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.Full text Abstract
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.Full text Abstract
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.Full text Abstract
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
- Hipertensão essencial
- Lesão renal aguda
- Dissecção da artéria renal
More DifferentialsGuidelines
- 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
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