Renovascular disease
1. Renal artery stenosis is associated with three main clinical syndromes: ischemic nephropathy, renovascular hypertension, and recurrent flash pulmonary edema. However, it may be completely asymptomatic.
2. Renal artery stenosis should be suspected in patients with resistant hypertension, abrupt onset of hypertension at a relatively young or old age, worsening blood pressure control in someone with previously well-controlled hypertension, recurrent episodes of flash pulmonary edema, unexplained kidney dysfunction, unexplained hypokalemia, an atrophic unilateral kidney, kidney failure precipitated by initiation of blockers of the renin-angiotensin system, an abdominal bruit, and the presence of atherosclerotic disease in other vascular beds.
3. Screening for suspected renal artery stenosis can be done with duplex ultrasonography, magnetic resonance angiography, or computed tomographic angiography. The gold standard diagnostic study is digital subtraction angiography, but this involves an invasive procedure.
4. Atherosclerotic renal artery stenosis commonly progresses anatomically and is associated with high mortality largely from cardiovascular causes.
