Renal artery stenosis resident survival guide: Difference between revisions
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Algorithm based on the 2013 AHA Guidelines Recommendations for Management of Patients with PAD.<ref name="pmid23457117">{{cite journal| author=Anderson JL, Halperin JL, Albert NM, Bozkurt B, Brindis RG, Curtis LH et al.| title=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. | journal=Circulation | year= 2013 | volume= 127 | issue= 13 | pages= 1425-43 | pmid=23457117 | doi=10.1161/CIR.0b013e31828b82aa | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23457117 }} </ref> | Algorithm based on the 2013 AHA Guidelines Recommendations for Management of Patients with PAD.<ref name="pmid23457117">{{cite journal| author=Anderson JL, Halperin JL, Albert NM, Bozkurt B, Brindis RG, Curtis LH et al.| title=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. | journal=Circulation | year= 2013 | volume= 127 | issue= 13 | pages= 1425-43 | pmid=23457117 | doi=10.1161/CIR.0b013e31828b82aa | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23457117 }} </ref> | ||
==Indications for Renal Revascularization== | |||
{{familytree/start}} | |||
{{familytree | | | | | | A02 | | A02= <table class="wikitable"> | |||
<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>'''2.''' Accelerated, resistant, or malignant hypertension</td><td>Class I; LOE C</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>'''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>'''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>'''9.''' Refractory angina</td><td>Class IIb; LOE C</td></tr> | |||
</table>}} | |||
{{familytree | | | | | | |!| | | | | | | | | | }} | |||
{{familytree | | | | | | A01 | | | A01= ❑'''If one or more of the above are present, proceed to further diagnostic testing'''}} | |||
{{familytree | | | | | | |!| | | | | | | | | | }} | |||
{{familytree | | | |,|-|-|^|-|-|.| | }} | |||
{{familytree | | | B01 | | | | B02 | B01=<div style="height: 1em; width: 25em; padding:1em;">'''Noninvasive Imaging''' | |||
</div>| B02= <div style="height: 1em; width: 25em; padding:1em;">'''Invasive Imaging''' | |||
</div>}} | |||
{{familytree | | | |!| | | | | |!| | }} | |||
{{familytree | | | C01 | | | | C02 | C01= <div style="float: left; text-align: left; height: 5em; width: 25em; padding:1em;">❑ Duplex ultrasound | |||
❑ Gadolinium enhanced MRA | |||
❑ CT angiography </div>| C02= <div style="height: 3em; width: 25em;">❑ Abdominal aortography to assess the renal arteries during coronary and peripheral angiography</div>}} | |||
{{familytree/end}} | |||
==References== | ==References== |
Revision as of 07:40, 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 | |||||||||||||||||||||||||||||||||||||
| |||||||||||||||||||||||||||||||||||||
❑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]
Indications for Renal Revascularization
| |||||||||||||||||||||||||||||||||||||
❑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 | ||||||||||||||||||||||||||||||||||||
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.