Sandboxkarol

Clinical Clues to the Diagnosis of RAS

Determine if one or more of the following is present: ❑ Onset of hypertension before the age of 30 years or severe hypertension after the age of 55 ❑ Accelerated, resistant, or malignant hypertension ❑ Development of new azotemia or worsening renal function after administration of an ACE inhibitor or ARB agent ❑ Unexplained atrophic kidney or size discrepancy between kidneys >1.5 cm ❑ Sudden, unexplained pulmonary edema ❑ Unexplained renal dysfunction, including individuals starting renal replacement therapy ❑ Multi-vessel CAD ❑ Unexplained CHF ❑ Refractory angina

❑If one of the above are present, proceed with Non- invasive imaging

❑If there are no clinical clues, proceed with invasive renal arteriography

Is patient allergic to contrast

If yes proceed with US

If no check for: ❑ Implanted devices: Pacemakers Defibrillators Cochlear implants Spinal cord stimulators ❑ Claustrophobic patient

❑ Abdominal aortography to assess the renal arteries during coronary and peripheralangiography

If none of the above proceed with MRA

If yes to any of the above, proceed with CT

Negative noninvasive test but with high clinical suspicion

Evidence of RAS

Evidence of RAS

Go to invasive imaging

Confirmed RAS: ❑Proceed to medical therapy ❑Consider revascularization