Diagnosis and Assessment
- Patients who present with 2 or more of the following clinical clues, which suggest renovascular hypertension, should be investigated (Grade D):
- Sudden onset or worsening of hypertension and age older than 55 or younger than 30 years;
- Presence of an abdominal bruit;
- Hypertension resistant to 3 drugs;
- Increase in serum creatinine level 30% associated with use of an ACE inhibitor or ARB;
- Other atherosclerotic vascular disease, particularly in patients who smoke or have dyslipidemia;
- Recurrent pulmonary edema associated with hyper-tensive surges.
- The following tests are recommended for screening for atherosclerotic renal vascular disease: captopril-enhanced radioisotope renal scan (for patients with eGFR > 60 mL/min/1.73 m2), Doppler sonography, computed to-mography angiography, and magnetic resonance angiog-raphy (for patients with eGFR > 30 mL/min/1.73 m2; Grade D; revised recommendation).
Patients with hypertension who present with at least 1 of the following clinical clues should be investigated for fibromus-cular dysplasia (FMD)-related renal artery stenosis (Grade D):
- Significant (> 1.5 cm), unexplained asymmetry in kidney sizes;
- Abdominal bruit without apparent atherosclerosis;
- FMD in another vascular territory;
- Family history of FMD.
- In patients with confirmed renal FMD (Grade D):
- Screening for cervicocephalic lesions and intracranial aneurysm is recommended;
- Screening for FMD in other vascular beds in the pres-ence of suggestive symptoms is recommended.
The following tests are recommended to screen for renal FMD (both with similar sensitivity and specificity; Grade D): magnetic resonance angiography and computed to-mography angiography.