Renal Artery Stenosis (RAS)

Question 1

define

Answer 1

narrowing of the renal arteries

Question 2

presentation

Answer 2

poor kidney function
hypertension
other signs of vascular disease e.g. claudication, bruit

Question 3

diagnosis

Answer 3

U&Es
USS (doppler is for arteries)
CT angiogram (use MRI to avoid radio-iodine contrast that is toxic to kidneys)

Question 4

management

Answer 4

CCB amlodipine

statin

Question 5

causes

Answer 5

atherosclerosis

in young females- fibromuscular dysplasia

Question 6

what does fibromuscular dysplasia present with

Answer 6

beading of renal artery.

Question 7

why does RAS cause hypertension

Answer 7

flow going in is reduced leaving only a trickle coming into the glomerulus. The juxtaglomerular apparatus (juxtaglomerular cells and macula densa) is fooled into thinking this is low blood pressure and there is secretion of renin

Question 8

what drugs do you NOT give in RAS?

Answer 8

NSAIDs

ACEI/ARB

Question 9

why do you not give NSAIDs

Answer 9

reduce prostaglandins PGE2 which is an important vasodilator

Question 10

why do you not give ACEI/ARB

Answer 10

need angiotensin to constrict vessel