Sandboxkarol: Difference between revisions
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{{familytree | | | | D01 | | | | | | | | |!| | D01=<div style="height: 1em; width: 15em; padding:1em;">'''Is patient allergic to contrast'''</div>}} | {{familytree | | | | D01 | | | | | | | | |!| | D01=<div style="height: 1em; width: 15em; padding:1em;">'''Is patient allergic to contrast'''</div>}} | ||
{{familytree | | |,|-|^|-|.| | | | | | | |!| | }} | {{familytree | | |,|-|^|-|.| | | | | | | |!| | }} | ||
{{familytree | | E01 | | E02 | | | | | | E03 | E01= If yes proceed with US | {{familytree | | E01 | | E02 | | | | | | E03 | E01= If yes proceed with US| E02=<div style="float: left; text-align: left; height: 12em; width: 10em;">If no check for: | ||
❑ Implanted devices: | ❑ Implanted devices: | ||
- Pacemakers | - Pacemakers |
Revision as of 18:41, 8 January 2014
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 yes: ❑ Proceed with non-invasive imaging | If no: ❑ 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 | |||||||||||||||||||||||||||||||||||||||||||