Renal artery stenosis resident survival guide
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Karol Gema Hernandez, M.D. [2]
Definition
This section provides a short and straight to the point definition of the disease or symptom in one sentence.
Causes
Life Threatening Causes
Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.
Common Causes
Clinical Clues to the Diagnosis of RAS
| ❑ Determine if one or more of the above is present | |||||||||||||||||||||||||||||||||||||
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| ❑If one or more of the above are present, proceed to further diagnostic testing | |||||||||||||||||||||||||||||||||||||
Noninvasive Imaging
| Invasive Imaging
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❑ Duplex ultrasound
❑ Gadolinium enhanced MRA ❑ CT angiography | ❑ Abdominal aortography to assess the renal arteries during coronary and peripheral angiography | ||||||||||||||||||||||||||||||||||||
Negative noninvasive test but with high clinical suspicion | Evidence of RAS | Evidence of RAS | |||||||||||||||||||||||||||||||||||
Renal angiography | |||||||||||||||||||||||||||||||||||||
Evidence of RAS | |||||||||||||||||||||||||||||||||||||
Confirmed RAS, proceed to treatment | |||||||||||||||||||||||||||||||||||||
Algorithm based on the 2013 AHA Guidelines Recommendations for Management of Patients with PAD.[1]
Indications for Renal Revascularization
{{
| Indication | Level of evidence |
|---|---|
| 1.Onset of hypertension before the age of 30 years or severe hypertension after the age of 55 | Class I; LOE B |
| 2. Accelerated, resistant, or malignant hypertension | Class I; LOE C |
| 3. Development of new azotemia or worsening renal function after administration of an ACE inhibitor or ARB agent | Class I; LOE B |
| 4. Unexplained atrophic kidney or size discrepancy between kidneys of greater than 1.5 cm | Class I; LOE B |
| 5. Sudden, unexplained pulmonary edema | Class I; LOE B |
| 6. Unexplained renal dysfunction, including individuals starting renal replacement therapy | Class IIa; LOE B |
| 7. Multi-vessel coronary artery disease | Class IIb; LOE B |
| 8. Unexplained congestive heart failure | Class IIb; LOE C |
| 9. Refractory angina | Class IIb; LOE C |
}}
| ❑Renal Angioplasty/Stent | |||||||||||||||||||||||||||||||||
Noninvasive Imaging
| Invasive Imaging
| ||||||||||||||||||||||||||||||||
❑ Duplex ultrasound
❑ Gadolinium enhanced MRA ❑ CT angiography | ❑ Abdominal aortography to assess the renal arteries during coronary and peripheral angiography | ||||||||||||||||||||||||||||||||
References
- ↑ Anderson JL, Halperin JL, Albert NM, Bozkurt B, Brindis RG, Curtis LH; et al. (2013). "Management of patients with peripheral artery disease (compilation of 2005 and 2011 ACCF/AHA guideline recommendations): a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines". Circulation. 127 (13): 1425–43. doi:10.1161/CIR.0b013e31828b82aa. PMID 23457117.