Sandboxkarol: Difference between revisions
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{{familytree | | | | J01 | |J01=<div style="float: left; text-align: left; height: 30em; 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>}} | {{familytree | | | | J01 | |J01=<div style="float: left; text-align: left; height: 30em; 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>}} | ||
{{familytree | | | | | | | | | | |!| | | | | | }} | {{familytree | | | | | | | | | | |!| | | | | | }} | ||
{{familytree | | | | |,|-|-|-|-|-|^ | {{familytree | | | | |,|-|-|-|-|-|^|-|-|-|.| }} | ||
{{familytree | | | | C01 | {{familytree | | | | C01 | | | | | | | | C02 | C01=<div style="height: 3em; width: 25em; padding:1em;">❑'''If one of the above are present, proceed with Non- invasive imaging'''</div>| C02= <div style="height: 3em; width: 25em; padding:1em;">❑'''If there are no clinical clues, proceed with invasive renal arteriography'''</div>}} | ||
{{familytree | | | | |! | {{familytree | | | | |!| | | | | | | | | |!| | | | | | | }} | ||
{{familytree | | | | |! | {{familytree | | | | |!| | | | | | | | | |!| }} | ||
{{familytree | | | | D01 | {{familytree | | | | D01 | | | | | | | | |!| | D01=<div style="height: 1em; width: 25em; padding:1em;">'''Is patient allergic to contrast'''</div>}} | ||
{{familytree | | |,|-|^|-|. | {{familytree | | |,|-|^|-|.| | | | | | | |!| | }} | ||
{{familytree | | E01 | | E02 | {{familytree | | E01 | | E02 | | | | | | E03 | E01= <div style="float: left; text-align: center; height: 1em; width: 25em; padding:1em;">If yes proceed with US </div>| E02=<div style="float: left; text-align: left; height: 12em; width: 25em;">If no check for: | ||
❑ Implanted devices: | ❑ Implanted devices: | ||
*Pacemakers | *Pacemakers | ||
Line 16: | Line 16: | ||
*Spinal cord stimulators | *Spinal cord stimulators | ||
❑ Claustrophobic patient </div>| E03= <div style="height: 3em; width: 25em;">❑ [[Abdominal aortography]] to assess the renal arteries during coronary and peripheral[[angiography]]</div>}} | ❑ Claustrophobic patient </div>| E03= <div style="height: 3em; width: 25em;">❑ [[Abdominal aortography]] to assess the renal arteries during coronary and peripheral[[angiography]]</div>}} | ||
{{familytree | | |!| |,|-|^|-|. | {{familytree | | |!| |,|-|^|-|.| | | | | |!| |}} | ||
{{familytree | | |!| F01 | | F02 | {{familytree | | |!| F01 | | F02 | | | | |!| | | | F01=<div style="height: 1em; width: 20em; padding:1em;">If none of the above proceed with [[MRA]] | ||
</div>| F02= <div style="height: 1em; width: 25em; padding:1em;">If yes to any of the above, proceed with [[CT]]</div>}} | </div>| F02= <div style="height: 1em; width: 25em; padding:1em;">If yes to any of the above, proceed with [[CT]]</div>}} | ||
{{familytree | | |`|-|-|+|-|-|' | {{familytree | | |`|-|-|+|-|-|'| | | | | |!| |}} | ||
{{familytree | | | |,|-|^|-|. | {{familytree | | | |,|-|^|-|.| | | | | | |!| |}} | ||
{{familytree | | | G01 | | G02 | {{familytree | | | G01 | | G02 | | | | | G03 | G01= <div style="height: 5em; width: 10em;">Negative noninvasive test but with high clinical suspicion </div>| G02= <div style="height: 3em; width: 10em;">Evidence of RAS </div>| G03= <div style="height: 3em; width: 10em;">Evidence of RAS </div>}} | ||
{{familytree | | | |!| | | |! | {{familytree | | | |!| | | |!| | | | | | |!| | }} | ||
{{familytree | | | H01 | | |! | {{familytree | | | H01 | | |!| | | | | | |!| H01= <div style="height: 2em; width: 10em; padding:1em;">Go to invasive imaging</div>}} | ||
{{familytree | | | | | | | |! | {{familytree | | | | | | | |!| | | | | | |!| | }} | ||
{{familytree | | | | | | | |`|-|-| I01 | {{familytree | | | | | | | |`|-|-| I01 |-|'| I01= <div style="height: 7.5em; width: 10em; padding:1em;">'''Confirmed RAS: | ||
❑Proceed to medical therapy | ❑Proceed to medical therapy | ||
❑Consider revascularization'''</div>}} | ❑Consider revascularization'''</div>}} | ||
{{familytree/end}} | {{familytree/end}} |
Revision as of 18:04, 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 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 | |||||||||||||||||||||||||||||||||||||||||||