Renovascular Hypertension and Renal Artery Stenosis

Question 1

What is renovascular hypertension?

Answer 1

secondary elevation of BP secondary to interference with arterial circulation to the kidney

Question 2

What percentage of stenosis is required to cause renovascular hypertension?

Answer 2

80%

Question 3

What percentage of hypertension is caused by renovascular hypertension?

Answer 3

1-3%

Question 4

What are the two main causes of renal artery stenosis?

Answer 4

atherosclerotic disease and fibromuscular dysplasia

Question 5

Which patients typically get fibromuscular dysplasia?

Answer 5

women aged 30-50

Question 6

What is the characteristic finding of fibromuscular dysplasia?

Answer 6

string of beads appearance in mid to distal renal artery

Question 7

What are risk factors for fibromuscular dysplasia?

Answer 7

smoking, pregnancy

Question 8

Which part of the renal artery is usually affected in RAS?

Answer 8

ostial/proximal portion

Question 9

What is the difference between unilateral and bilateral RAS?

Answer 9

in unilateral there is increased renin and normal volume state
in bilateral there is normal renin but increased volume state

Question 10

In which patients should you suspect renovascular stenosis?

Answer 10

age < 30 or > 50
abrupt onset HTN
acceleration of previously stable BP
malignant HTN
accelerated retinopathy
flash APO
AKI with ACEI

Question 11

What is the difference between the sensitivity and specificity for doppler US vs CT renal angiogram?

Answer 11

better sensitivity for doppler US, better specificity for CT

Question 12

What is the gold standard for diagnosis?

Answer 12

angiography

Question 13

What is the management for renovascular hypertension?

Answer 13

RAAS blockade
lifestyle modification
CV risk factor control
?angioplasty - if FMD, maybe if RAS high risk