Renal artery stenosis resident survival guide: Difference between revisions
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{{familytree | | | | | | A01 | | | A01= ❑ '''Determine if one or more of the above is present'''}} | {{familytree | | | | | | A01 | | | A01= ❑ '''Determine if one or more of the above is present'''}} | ||
{{familytree | | | | | | |!| | | | | | | | }} | {{familytree | | | | | | |!| | | | | | | | }} | ||
{{familytree | | | | | | A02 | | A02= <table class="wikitable"<div style="height: 25em; width: 25em; | {{familytree | | | | | | A02 | | A02= <table class="wikitable"<div style="height: 25em; width: 25em;> | ||
<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> |
Revision as of 07:22, 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 | |||||||||||||||||||||||||||||
<table class="wikitable" | |||||||||||||||||||||||||||||
Scenario | Level of evidence | ||||||||||||||||||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
1.Onset of hypertension before the age of 30 years or severe hypertension after the age of 55 | Class I; LOE B | ||||||||||||||||||||||||||||
2. Accelerated, resistant, or malignant hypertension | Class I; LOE C | ||||||||||||||||||||||||||||
3. Development of new azotemia or worsening renal function after administration of an ACE inhibitor or ARB agent | Class I; LOE B | ||||||||||||||||||||||||||||
4. Unexplained atrophic kidney or size discrepancy between kidneys of greater than 1.5 cm | Class I; LOE B | ||||||||||||||||||||||||||||
5. Sudden, unexplained pulmonary edema | Class I; LOE B | ||||||||||||||||||||||||||||
6. Unexplained renal dysfunction, including individuals starting renal replacement therapy | Class IIa; LOE B | ||||||||||||||||||||||||||||
7. Multi-vessel coronary artery disease | Class IIb; LOE B | ||||||||||||||||||||||||||||
8. Unexplained congestive heart failure | Class IIb; LOE C | ||||||||||||||||||||||||||||
9. Refractory angina | Class IIb; LOE C |
❑If one or more of the above are present, proceed to further diagnostic testing
Noninvasive Imaging
Invasive Imaging
❑ Duplex ultrasound
❑ Gadolinium enhanced MRA
❑ CT angiography❑ Abdominal aortography to assess the renal arteries during coronary and peripheral angiography
Negative noninvasive test but with high clinical suspicion
Evidence of RAS
Evidence of RAS
Renal angiography
Evidence of RAS
Confirmed RAS, proceed to treatment
Algorithm based on the 2013 AHA Guidelines Recommendations for Management of Patients with PAD.[1]
References
- ↑ Anderson JL, Halperin JL, Albert NM, Bozkurt B, Brindis RG, Curtis LH; et al. (2013). "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. 127 (13): 1425–43. doi:10.1161/CIR.0b013e31828b82aa. PMID 23457117.