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(Created page with "===Clinical Clues to the Diagnosis of RAS=== {{familytree/start}} {{familytree | | | | | | | | | | A01 | | | | A01= ❑ '''Determine if one or more of the following is present...") |
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===Clinical Clues to the Diagnosis of RAS=== | ===Clinical Clues to the Diagnosis of RAS=== | ||
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{{familytree | | | | | | | | | | A01 | | | | A01 | {{familytree | | | | | | | | | | A01 | | | | A01= <div style="float: left; text-align: left; height: 10em; width: 20em; padding:1em;">'''Determine if one or more of the following is present:'''<br> ❑ Onset of hypertension before the age of 30 years or severe hypertension after the age of 55 <br> ❑ Accelerated, resistant, or [[malignant hypertension]] <br> ❑ Development of new [[azotemia]] or worsening renal function after administration of an [[ACE inhibitor]] or [[ARB]] agent <br> ❑ Unexplained [[atrophic kidney]] or size discrepancy between kidneys >1.5 cm <br> ❑ Sudden, unexplained pulmonary edema <br> ❑ Unexplained renal dysfunction, including individuals starting renal replacement therapy <br> ❑ Multi-vessel [[CAD]] <br> ❑ Unexplained [[CHF] <br> ❑ Refractory [[angina]]</div>}} | ||
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Revision as of 17:57, 8 January 2014
Clinical Clues to the Diagnosis of RAS
{{familytree | | | | | | | | | | A01 | | | | A01=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
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❑ 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:
| ❑ 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 | |||||||||||||||||||||||||||||||||||||||||||||