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| ===Clinical Clues to the Diagnosis of RAS===
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| {{familytree | | | | J01 | | J01=<div style="float: left; text-align: left ; height: 30em; width: 20em; padding:1em;"> '''Determine if one or more of the following is present:''' <br> ❑ Onset of hypertension before the age of 30 years or severe hypertension after the age of 55<br> ❑ Accelerated, resistant, or [[ malignant hypertension]]<br> ❑ Development of new [[azotemia]] or worsening renal function after administration of an [[ ACE inhibitor]] or [[ARB]] agent<br> ❑ Unexplained [[atrophic kidney]] or size discrepancy between kidneys >1.5 cm<br> ❑ Sudden, unexplained pulmonary edema<br> ❑ Unexplained renal dysfunction, including individuals starting renal replacement therapy<br>❑ Multi- vessel [[ CAD]]<br> ❑ Unexplained [[ CHF]]<br> ❑ Refractory [[angina]] </div>}} | | {{familytree | | | | | | | A01 | | | | | | | | A01= '''High risk criteria:''' <br><div style="float: left; text-align: left;"> ❑ Severe structural or [[ CAD]]<br>❑ Clinical or [[ ECG]] features suggesting arrhythmic syncope: <br> -syncope during exertion or supine <br> -palpitations at the time of syncope <br> - family history of[[ SCD]] <br> -non- sustained [[ VT]] <br> - conduction abnormalities with QRS > 120 ms < br> -[[ sinus bradycardia]] < br> - pre- exited QRS complex < br> -prolonged or short QR interval < br> -brugada pattern < br> -[[ ARVC]] < br> ❑ Important comorbidities: < br> -Severe anemia < br> - Electrolyte intolerance </div> }} |
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| {{familytree | | | | C01 | | | | | | | | C02 | C01=<div style="height: 3em; width: 10em; padding:1em;">❑'''If one of the above are present, proceed with Non- invasive imaging'''</div>| C02= <div style="height: 3em; width: 10em; padding:1em;">❑'''If there are no clinical clues, proceed with invasive renal arteriography'''</div>}}
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| {{familytree | | | | D01 | | | | | | | | |!| | D01=<div style="height: 1em; width: 10em; padding:1em;">'''Is patient allergic to contrast'''</div>}}
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| {{familytree | | E01 | | E02 | | | | | | E03 | E01= <div style="float: left; text-align: center; height: 1em; width: 10em; padding:1em;">If yes proceed with US </div>| E02=<div style="float: left; text-align: left; height: 12em; width: 10em;">If no check for:
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| ❑ Implanted devices:
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| *Pacemakers
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| *Defibrillators
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| *Cochlear implants
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| *Spinal cord stimulators
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| ❑ Claustrophobic patient </div>| E03= <div style="height: 3em; width: 25em;">❑ [[Abdominal aortography]] to assess the renal arteries during coronary and peripheral[[angiography]]</div>}}
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| {{familytree | | |!| F01 | | F02 | | | | |!| | | | F01=<div style="height: 1em; width: 10em; padding:1em;">If none of the above proceed with [[MRA]]
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| </div>| F02= <div style="height: 1em; width: 10em; padding:1em;">If yes to any of the above, proceed with [[CT]]</div>}} | |
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| {{familytree | | | G01 | | G02 | | | | | G03 | G01= <div style="height: 5em; width: 10em;">Negative noninvasive test but with high clinical suspicion </div>| G02= <div style="height: 3em; width: 10em;">Evidence of RAS </div>| G03= <div style="height: 3em; width: 10em;">Evidence of RAS </div>}}
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| {{familytree | | | H01 | | |!| | | | | | |!| H01= <div style="height: 2em; width: 10em; padding:1em;">Go to invasive imaging</div>}}
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| {{familytree | | | | | | | |`|-|-| I01 |-|'| I01= <div style="height: 7.5em; width: 10em; padding:1em;">'''Confirmed RAS:
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| ❑Proceed to medical therapy
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| ❑Consider revascularization'''</div>}}
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| {{familytree/end}} | | {{familytree/end}} |