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===Clinical Clues to the Diagnosis of RAS=== | ===Clinical Clues to the Diagnosis of RAS=== | ||
{{familytree/start}} | {{familytree/start}} | ||
{{familytree | | | | | | | | | | A01 | |A01=<div style="float: left; text-align: left; height: | {{familytree | | | | | | | | | | A01 | |A01=<div style="float: left; text-align: left; height: 28em; 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 | | | | | | | | C02 | C01='''If yes:''' <br> <div style=height: 1em; width: 10em; padding:1em;">❑ Proceed with non-invasive imaging<br> </div>| C02= '''If no:'''<br> <div style=height: 1em; width: 10em; padding:1em;">❑ Proceed with invasive renal arteriography | {{familytree | | | | C01 | | | | | | | | C02 | C01='''If yes:''' <br> <div style=height: 1em; width: 10em; padding:1em;">❑ Proceed with non-invasive imaging<br> </div>| C02= '''If no:'''<br> <div style=height: 1em; width: 10em; padding:1em;">❑ Proceed with invasive renal arteriography </div>}} | ||
{{familytree | | | | |!| | | | | | | | | |!| | | | | | | }} | {{familytree | | | | |!| | | | | | | | | |!| | | | | | | }} | ||
{{familytree | | | | |!| | | | | | | | | |!| }} | {{familytree | | | | |!| | | | | | | | | |!| }} | ||
{{familytree | | | | D01 | | | | | | | | |!| | D01=<div style="height: 1em; width: 15em; padding:1em;">'''Is patient allergic to contrast'''</div>}} | {{familytree | | | | D01 | | | | | | | | |!| | D01=<div style="height: 1em; width: 15em; padding:1em;">'''Is patient allergic to contrast'''</div>}} | ||
{{familytree | | |,|-|^|-|.| | | | | | | |!| | }} | {{familytree | | |,|-|^|-|.| | | | | | | |!| | }} | ||
{{familytree | | E01 | | E02 | | | | | | E03 | E01= '''If yes:'''<br> <div style=height: 1em; width: 10em; padding:1em;">❑ Proceed with US | {{familytree | | E01 | | E02 | | | | | | E03 | E01= '''If yes:'''<br> <div style=height: 1em; width: 10em; padding:1em;">❑ Proceed with US| E02= '''If no check for:''' <br><div style=height: 15em; width: 10em; padding:1em;"> | ||
❑ Implanted devices: | ❑ Implanted devices: | ||
- Pacemakers | - Pacemakers | ||
Line 15: | Line 15: | ||
- Cochlear implants | - Cochlear implants | ||
- Spinal cord stimulators <br> | - Spinal cord stimulators <br> | ||
❑ Claustrophobic patient | ❑ 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 | | | | |!| | | | F01=<div style="height: 1em; width: 10em; padding:1em;">If none of the above proceed with [[MRA]] | {{familytree | | |!| F01 | | F02 | | | | |!| | | | F01=<div style="height: 1em; width: 10em; padding:1em;">If none of the above proceed with [[MRA]] |
Revision as of 18:51, 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 yes: ❑ Proceed with non-invasive imaging | If no: ❑ Proceed with invasive renal arteriography | ||||||||||||||||||||||||||||||||||||||||||
Is patient allergic to contrast | |||||||||||||||||||||||||||||||||||||||||||
If yes: ❑ Proceed with US | If no check for: ❑ Implanted devices:
- Pacemakers
- Defibrillators
- Cochlear implants
- Spinal cord stimulators | ❑ 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 | |||||||||||||||||||||||||||||||||||||||||||