Renal artery stenosis differential diagnosis: Difference between revisions
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==Overview== | |||
Renal artery stenosis should be differentiated from [[essential hypertension]] and other causes of [[secondary hypertension]]. | |||
==Differentiating Renal Artery Stenosis from Essential Hypertension== | ==Differentiating Renal Artery Stenosis from Essential Hypertension== | ||
Revision as of 19:06, 14 May 2014
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Renal artery stenosis should be differentiated from essential hypertension and other causes of secondary hypertension.
Differentiating Renal Artery Stenosis from Essential Hypertension
Hypertensive patients afflicted with renal artery stenosis often have one or more of the following characteristics:
- Onset of hypertension before the age of 30 years
- Onset of severe hypertension (SBP ≥180 mm Hg and/or DBP ≥120 mm Hg) after the age of 55 years
- New azotemia or worsening renal function after administration of an ACE inhibitor or ARB agent
- Unexplained atrophic kidney or size discrepancy between kidneys of greater than 1.5 cm
- Sudden, unexplained pulmonary edema
- Accelerated hypertension (sudden and persistent worsening of previously controlled hypertension)
- Resistant hypertension (failure to achieve goal blood pressure in patients who are adhering to full doses of an appropriate 3-drug regimen that includes a diuretic)
- Malignant hypertension (hypertension with coexistent evidence of acute end-organ damage, i.e., acute renal failure, acutely decompensated congestive heart failure, new visual or neurological disturbance, and/or advanced [grade III to IV] retinopathy)
- Unexplained renal failure in the absence of proteinuria or an abnormal urine sediment
- Multivessel coronary artery disease
- Unexplained congestive heart failure
- Refractory angina
Noninvasive diagnostic studies such as Duplex ultrasound, CT angiography, or magnetic resonance angiography are indicated in the presence of any above-mentioned conditions. If the results of noninvasive screening are inconclusive, catheter angiography may be considered.[1][2]
References
- ↑ Hirsch AT, Haskal ZJ, Hertzer NR, Bakal CW, Creager MA, Halperin JL; et al. (2006). "ACC/AHA 2005 Practice Guidelines for the management of patients with peripheral arterial disease (lower extremity, renal, mesenteric, and abdominal aortic): a collaborative report from the American Association for Vascular Surgery/Society for Vascular Surgery, Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, Society of Interventional Radiology, and the ACC/AHA Task Force on Practice Guidelines (Writing Committee to Develop Guidelines for the Management of Patients With Peripheral Arterial Disease): endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation; National Heart, Lung, and Blood Institute; Society for Vascular Nursing; TransAtlantic Inter-Society Consensus; and Vascular Disease Foundation". Circulation. 113 (11): e463–654. doi:10.1161/CIRCULATIONAHA.106.174526. PMID 16549646.
- ↑ Rooke TW, Hirsch AT, Misra S, Sidawy AN, Beckman JA, Findeiss LK; et al. (2011). "2011 ACCF/AHA Focused Update of the Guideline for the Management of Patients With Peripheral Artery Disease (updating the 2005 guideline): a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines". J Am Coll Cardiol. 58 (19): 2020–45. doi:10.1016/j.jacc.2011.08.023. PMID 21963765.