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===Clinical Clues to the Diagnosis of RAS=== | ===Clinical Clues to the Diagnosis of RAS=== | ||
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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>}} | ||
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Revision as of 18:09, 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 | |||||||||||||||||||||||||||||||||||||||||||