Renal artery stenosis differential diagnosis
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
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.