Renal artery stenosis resident survival guide: Difference between revisions

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<tr class="v-firstrow"><th>Scenario</th><th>Level of evidence</th></tr>
<tr class="v-firstrow"><th>Scenario</th><th>Level of evidence</th></tr>
<tr><td>'''1.'''Onset of hypertension before the age of 30 years or severe hypertension after the age of 55.    </td><td>Class I; LOE B</td></tr>
<tr><td>'''1.'''Onset of hypertension before the age of 30 years or severe hypertension after the age of 55</td><td>Class I; LOE B</td></tr>
<tr><td>Heparin therapeutic dose</td><td>1-5 </td></tr>
<tr><td>Heparin therapeutic dose</td><td>1-5 </td></tr>
 
<tr><td>2. Accelerated, resistant, or malignant hypertension</td><td>Class I; LOE C</td></tr>
<tr><td>Heparin flushes</td><td>0.1-1 </td></tr>
<tr><td>3. Development of new azotemia or worsening renal function after administration of an ACE inhibitor or ARB agent</td><td>Class I; LOE B</td></tr>
 
<tr><td>4. Unexplained atrophic kidney or size discrepancy between kidneys of greater than 1.5 cm</td><td>Class I; LOE B</td></tr>
<tr><td>[[LMWH]] prophylactic or therapeutic dose</td><td>0.1-1 </td></tr>
<tr><td>5. Sudden, unexplained pulmonary edema</td><td>Class I; LOE B</td></tr>
 
<tr><td>6. Unexplained renal dysfunction, including individuals starting renal replacement therapy</td><td>Class IIa; LOE B</td></tr>
<tr><td>Cardiac surgery patients</td><td>1-3 </td></tr>
<tr><td>7. Multi-vessel coronary artery disease</td><td>Class IIb; LOE B</td></tr>
 
<tr><td>8. Unexplained congestive heart failure</td><td>Class IIb; LOE C</td></tr>
<tr><td>'''Medical patients''' </td><td> </td></tr>
<tr><td>9. Refractory angina</td><td>Class IIb; LOE C</td></tr>
 
<tr><td>Patients with [[malignacy]]</td><td>1 </td></tr>
 
<tr><td>Heparin prophylactic or therapeutic dose</td><td>0.1-1 </td></tr>
 
<tr><td>LMWH, prophylactic or therapeutic dose</td><td>0.6 </td></tr>
 
<tr><td>Intensive care unit patients</td><td>0.4 </td></tr>
 
<tr><td>Heparin flushes</td><td>< 0.1 </td></tr>
 
<tr><td>Obstetrics patients</td><td> <0.1 </td></tr>
 
</table>}}
</table>}}


Revision as of 05:58, 6 January 2014

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Karol Gema Hernandez, M.D. [2]

Definition

This section provides a short and straight to the point definition of the disease or symptom in one sentence.

Causes

Life Threatening Causes

Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.

Common Causes

Clinical Clues to the Diagnosis of RAS

 
 
❑ Determine if one or more of the above is present
 
 
 
 
 
 
 
 
 
 
 
 
ScenarioLevel of evidence
1.Onset of hypertension before the age of 30 years or severe hypertension after the age of 55Class I; LOE B
Heparin therapeutic dose1-5
2. Accelerated, resistant, or malignant hypertensionClass I; LOE C
3. Development of new azotemia or worsening renal function after administration of an ACE inhibitor or ARB agentClass I; LOE B
4. Unexplained atrophic kidney or size discrepancy between kidneys of greater than 1.5 cmClass I; LOE B
5. Sudden, unexplained pulmonary edemaClass I; LOE B
6. Unexplained renal dysfunction, including individuals starting renal replacement therapyClass IIa; LOE B
7. Multi-vessel coronary artery diseaseClass IIb; LOE B
8. Unexplained congestive heart failureClass IIb; LOE C
9. Refractory anginaClass IIb; LOE C
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Risk <1%
 
Risk >1%
 
 
 
 
 
 
 
 
 
 
❑ Do not monitor platelet count
 
❑ Monitor platelet count every 2 or 3 days from day 4 to day 14 (or until heparin is stopped)

Algorithm based on the 2012 ACCP evidence based clinical practice guidelines.[1]



References


Template:WikiDoc Sources

  1. ↑ Linkins LA, Dans AL, Moores LK, Bona R, Davidson BL, Schulman S; et al. (2012). "Treatment and prevention of heparin-induced thrombocytopenia: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines". Chest. 141 (2 Suppl): e495S–530S. doi:10.1378/chest.11-2303. PMC 3278058. PMID 22315270.
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