![]() Useful if there is a dedicated team of physicians and technologists who are skilled in the test Similar to magnetic resonance angiography in accuracy requires intravenous iodinated contrast media Requires intravenous gadolinium contrast agents accurate in diagnosing renal artery stenosisĬomputed tomographic angiography of kidney Variant 1: High index of suspicion of renovascular hypertension and normal renal function Following reduction of the stenoses, the patient's hypertension improved, with subsequent blood pressure readings in the 150s/80s mm Hg. Fibromuscular dysplasia involving the mid-right renal artery was discovered and treated with balloon angioplasty before the stent placement. Catheter-directed renal artery angioplasty with stent placement was performed, and the ostial lesion was identified and treated ( Figures 3B and 3C). This demonstrated a tight ostial (proximal) stenosis that is typical of atherosclerosis ( Figure 3A). Computed tomographic angiography was performed on this patient with normal renal function. Given the uncontrollable nature of her hypertension, renal artery stenosis was suspected. Her serum creatinine level was 1.0 mg per dL (90 μmol per L). Her physical examination was unremarkable specifically, no abdominal bruit was identified. Her blood pressure reading at the time of examination was 212/103 mm Hg. This article is a summary of the recommendations, with the advantages and limitations of each test.Ī 69-year-old woman with obesity presented with a five-year history of uncontrolled hypertension, despite multiple medications, and a recent onset of type 2 diabetes. The American College of Radiology has developed appropriateness criteria for imaging tests related to the diagnosis of renal artery stenosis. ![]() However, caution is warranted because exposure to gadolinium contrast agents is associated with nephrogenic systemic fibrosis in patients with renal failure. ![]() For patients with diminished renal function, gadolinium-enhanced contrast magnetic resonance angiography is the best imaging test. For patients with normal renal function but a high clinical index of suspicion for renovascular disease, contrast-enhanced magnetic resonance angiography and computed tomographic angiography are the most accurate imaging tests. Duplex Doppler ultrasonography is a good screening test in many patients, but it has limitations in larger persons and can overlook small accessory arteries. ![]() Detecting renal artery stenosis is particularly important for ensuring that this potentially curable form of hypertension is identified and treated properly. Up to 5 percent of all occurrences of hypertension are caused by renal artery stenosis, equating to as many as 3.5 to 4 million occurrences in the United States. The most common cause of secondary hypertension is renal vascular hypertension, of which renal artery stenosis is the leading pathology. However, a significant subset has a secondary cause. More than 72 million Americans have hypertension, and the majority of these persons have essential hypertension. ![]()
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