Materiały źródłowe

• #1 Renal Artery Stenosis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK430718/

  Renal artery stenosis is narrowing of the one or both of renal arteries. It is the major cause of hypertension and according to some reports is the cause of hypertension in 1% to 10% of the 50 million people in the United States. […] This activity reviews the cause, pathophysiology, and presentation of renal artery stenosis and highlights the role of the interprofessional team in its management. […] Describe the evaluation of a patient with renal artery stenosis. […] The gold standard for diagnosing renal artery stenosis is renal arteriography. However, a variety of less invasive tests are being employed for evaluation for testing purposes. […] The choice of test should be based upon institutional expertise and patient factors. […] If the noninvasive test is inconclusive and the clinical suspicion remains high, conventional renal arteriography is recommended.

• #1 Diagnosing Renal Artery Stenosis | NYU Langone Health

  https://nyulangone.org/conditions/renal-artery-stenosis/diagnosis

  NYU Langone doctors are experts at diagnosing renal artery stenosis. The condition results from a narrowing of one or both renal arteries, the blood vessels that lead to the kidneys. […] Your NYU Langone cardiologist may suspect renal artery stenosis if you’re middle-aged and medications have failed to lower your high blood pressure. […] First, the doctor conducts a physical examination to look for symptoms such as swelling in the ankles. He or she also checks your blood pressure and takes a medical history to assess your health. Your doctor may order one or more of the following tests. […] If your doctor suspects you have renal artery stenosis, he or she may order a Doppler ultrasound to view blood flow in the renal arteries. The test allows doctors to assess plaque buildup and identify narrowing of the arteries.

• #1 Renal artery stenosis – Symptoms, diagnosis and treatment | BMJ Best Practice

  https://bestpractice.bmj.com/topics/en-gb/435

  Renal artery stenosis (RAS) is typically due to atherosclerotic disease or fibromuscular dysplasia. […] RAS often presents with accelerated or difficult-to-control hypertension. […] Definitive diagnosis is with imaging. […] History and exam […] Key diagnostic factors […] presence of key risk factors […] onset of hypertension age 55 years […] history of accelerated, malignant, or resistant hypertension […] history of unexplained kidney dysfunction […] history of multi-vessel coronary artery disease […] history of other peripheral vascular disease […] abdominal bruit […] sudden or unexplained recurrent pulmonary oedema […] onset of hypertension age 30 years. […] 1st investigations to order […] serum creatinine […] serum potassium […] urinalysis and sediment evaluation

• #1 Renal Artery Stenosis: Treatment, Symptoms, and More

  https://www.healthline.com/health/renal-artery-stenosis

  Renal artery stenosis (RAS) is a condition in which the arteries that supply blood to the kidneys narrow. […] Often, RAS is detected during an examination for another condition, such as hypertension. After your doctor performs a physical exam and looks at your medical records for any risk factors, theyll likely order a urine test to measure proteins and overall kidney function. A blood test can also measure both kidney function and blood pressure-regulating hormones. […] Your doctor may also order one or more of the following imaging tests to get a better look at your renal arteries: CT scan, magnetic resonance angiography (MRA), a test that provides 3-D images of the area being investigated, renal arteriography, which involves injecting a contrast material into your blood vessels so they show up on X-rays, ultrasound.

• #1 Renal Artery Stenosis Workup: Laboratory Studies, Imaging Studies

  https://emedicine.medscape.com/article/245023-workup

  Obtain serum creatinine levels to assess the level of kidney dysfunction. […] Studies designed to assess the renin-angiotensin system are of little diagnostic utility in patients with atherosclerotic renovascular disease (RVD). […] Renal ultrasonography scanning is performed frequently in patients with kidney dysfunction. […] Duplex ultrasonographic scanning combines a B-mode ultrasonographic image with a pulse Doppler unit to obtain flow velocity data. […] Radermacher et al reported that the renal resistance index, calculated through the use of color Doppler ultrasonography, can be used to predict the outcome of invasive therapy for renal artery stenosis. […] Use of radionuclide scanning, particularly following a single dose of captopril, is more useful in patients with normal kidney function, in whom fibromuscular disease is suspected.

• #1 Renal Artery Stenosis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK430718/

  Duplex Doppler ultrasonography is a noninvasive, relatively inexpensive technique that can be used in patients with any level of renal function. […] The first approach involves direct scanning of the main renal arteries with color or power Doppler US followed by spectral analysis of renal artery flow using an anterior or anterolateral approach. […] The presence of an early systolic peak can be interpreted as a sign of normality; however, the absence of an early systolic peak is not necessarily indicative of stenosis. […] The degree of renal artery stenosis that would justify any intervention attempt is greater than 80% in patients with bilateral stenosis or stenosis in a solitary functioning kidney regardless of whether they have renal insufficiency or not. […] When renal function is normal or nearly normal, revascularization is recommended for prevention of renal insufficiency if the patient fulfills the mentioned criteria. […] When renal function abnormality is present, the criteria for revascularization are as follows: The degree of stenosis is higher than 80%.

• #1 Renal artery stenosis – Wikipedia

  https://en.wikipedia.org/wiki/Renal_artery_stenosis

  Renal artery stenosis (RAS) is the narrowing of one or both of the renal arteries, most often caused by atherosclerosis or fibromuscular dysplasia. […] The diagnosis of renal artery stenosis can use many techniques to determine if the condition is present, a clinical prediction rule is available to guide diagnosis. […] Among the diagnostic techniques are: Doppler ultrasound study of the kidneys, refractory hypertension, auscultation (with stethoscope) – bruit („rushing” sound), Captopril challenge test, Captopril test dose effect on the differential renal function as measured by MAG3 scan, renal artery arteriogram. […] The specific criteria for renal artery stenosis on Doppler are an acceleration time of greater than 70 milliseconds, an acceleration index of less than 300 cm/sec and a velocity ratio of the renal artery to aorta of greater than 3.5.

• #1 Renal Artery Stenosis: Symptoms, Diagnosis and Therapy

  http://www.urology-textbook.com/renal-artery-stenosis.html

  Elevated renin concentration (80% sensitivity and specificity if antihypertensive medication was paused). […] Renal Doppler sonography misses the diagnosis (false negative) in 10-20%. […] A PSV of 180 cm/s and an EDV of 80 cm/s speak in favor of renal artery stenosis. […] A reno-aortic ratio (RAR) 3.5 is typical for renal artery stenosis (if a normal flow in the aorta is present). […] An RI below 0.5 indicates significant renal artery stenosis, but this is not sufficient as the sole diagnostic criterion. […] The test has a 90% sensitivity and specificity for the presence of a hemodynamically significant renal artery stenosis. […] Invasive angiography is the gold standard of renal artery stenosis imaging. […] Renal biopsy reveals the extent of ischemic renal damage due to renal artery stenosis and may predict the therapeutic success of revascularization.

• #1 Diagnosing Renal Artery Stenosis | NYU Langone Health

  https://nyulangone.org/conditions/renal-artery-stenosis/diagnosis

  An MRI uses a magnetic field and radio waves to create computerized, three-dimensional images of structures in the body. It can help your doctor identify narrowing in the renal arteries and assess whether the kidneys are functioning properly. […] A CT scan uses a series of X-rays to produce cross-sectional images of the renal arteries. This can help your doctor identify any narrowing of the arteries. […] This test uses X-rays and a contrast dye to produce images of the renal arteries. It can help identify artery narrowing that can lead to kidney damage that may not be visible on an ultrasound, MRI, or CT scan.

• #1 Renal Artery Stenosis Workup: Laboratory Studies, Imaging Studies

  https://emedicine.medscape.com/article/245023-workup

  Spiral CT angiography is a useful technique that avoids arterial catheterization and produces accurate images of renal artery anatomy. […] Magnetic resonance angiography (MRA) is a noninvasive technique capable of demonstrating the renal vascular anatomy and revealing physiologic information about kidney function. […] The limitations of MRA are its expense and its contraindication in patients with metallic clips, pacemakers, intraocular metallic devices, or other implants. […] Conventional aortography produces excellent radiographic images of the renal artery, but it requires an arterial puncture, carries the risk of cholesterol emboli, and uses a moderate amount of contrast material with the risk of contrast-induced acute tubular necrosis (ATN). […] Patients with progressive ischemic nephropathy (ie, underlying chronic kidney disease) are at risk for contrast nephrotoxicity and should be informed of this risk prior to any contrast procedure.

• #1 Diagnosis and Management of Atherosclerotic Renal Artery Stenosis

  https://www.medscape.org/viewarticle/588519_4

  The resistance index, which is an adjunctive measure obtained during renal DUS, is the ratio of the peak systolic to end diastolic velocity within the renal parenchyma at the level of the cortical blood vessels. […] CTA is often used in patients who cannot be adequately imaged with DUS, such as very obese patients, or patients with excessive abdominal gas. […] Depending on the specific technique used, CTA has excellent sensitivity (89-100%) and specificity (82-100%) for detecting RAS. […] MRA, like CTA, provides excellent imaging of the abdominal vasculature and associated anatomical structures. […] A study by Silva et al. of 27 patients with poorly controlled hypertension and RAS (=70% stenosis), showed that BNP was elevated before stent placement and fell within 24 h of successful stent placement.

• #1 Evaluating Renal Artery Stenosis using MRI Techniques | UCSF Radiology

  https://radiology.ucsf.edu/blog/abdominal-imaging/evaluating-renal-artery-stenosis-using-mri-techniques

  Narrowing of the arteries supplying the kidneys, known as renal artery stenosis, is the most common potentially reversible cause of high blood pressure and kidney failure in the United States. Early diagnosis of renal artery stenosis is critical to prevent permanent and irreversible kidney damage. Imaging plays an essential role in the prompt and accurate detection of renal artery stenosis. Imaging studies used to diagnose renal artery stenosis include ultrasound, computed tomography (CT), and magnetic resonance imaging (MRI). CT and MRI following intravenous injection of contrast material can provide exquisite details of the renal arterial anatomy, and are highly accurate for the diagnosis of renal artery stenosis. The Department of Radiology and Biomedical Imaging at UCSF now offers a new MRI technique called Inhance, which can be used to evaluate arteries, including those supplying the kidneys, without the need for contrast injections. A recently published study compared the performance of this new technique to traditional MRI with contrast injection, and showed that there was good agreement between the two methods for the detection of significant (50%) renal artery stenosis. The new non-contrast MR technique therefore should prove valuable for evaluating patients with suspected renal artery stenosis who are unable to undergo traditional contrast enhanced MRI.

• #1 Renal Artery Stenosis Workup: Laboratory Studies, Imaging Studies

  https://emedicine.medscape.com/article/245023-workup

  Accurate identification of patients with correctable renovascular hypertension can be difficult with use of standard noninvasive techniques (eg, sonography) because they provide only indirect evidence of the presence of renal artery lesions. […] The obvious advantages of conventional angiography are its ability to determine the clinical importance of suggestive lesions and the ability to concurrently perform endovascular therapy.

• #1 Diagnosis and Management of Atherosclerotic Renal Artery Stenosis

  https://www.medscape.org/viewarticle/588519_4

  The indications for screening angiography for RAS at the time of cardiac or peripheral angiography of other vascular beds were addressed by AHA and ACC recommendations and guidelines published in 2006. […] A visually estimated stenosis of 70% or greater is considered hemodynamically significant, and is a generally accepted indication for percutaneous intervention. […] The relief of hemodynamic obstruction (translesional pressure gradient) without injury to the renal parenchyma, rather than the cosmetic improvement of angiographic stenosis, is the ultimate goal of RAS reperfusion. An expert consensus panel of the AHA recommended that a peak systolic gradient of at least 20 mmHg, or a mean pressure gradient of 10 mmHg, be used to identify candidate lesions for revascularization in symptomatic patients with RAS. […] Another method to determine the severity of angiographic RAS is to quantify the fractional flow reserve (FFR).

• #1 Renal Artery Stenosis: Diagnosis and Management

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8099354/

  The choice of the imaging test(s) to diagnose renovascular hypertension is mostly dependent on local facilities and local expertise. […] It has been recommended that testing should be staged according to the pretest probability for renovascular hypertension: low probability (5%), no further testing; intermediate probability (5%-15%), noninvasive testing first, followed by renal arteriography if positive; and high probability (15%), renal arteriography. […] Recent data show that surgical or percutaneous revascularization may not be successful in all cases of renal artery stenosis, and that a noninvasively determined index from the segmental renal arteries could reliably identify patients with renal artery stenosis in whom revascularization will not improve renal function, blood pressure, or kidney survival.

• #1 How to manage renovascular hypertension

  https://www.escardio.org/Journals/E-Journal-of-Cardiology-Practice/Volume-13/How-to-manage-renovascular-hypertension

  Useful noninvasive tools frequently used in clinical practice are: duplex ultrasonography (DUS), CT angiography (CTA) and MR angiography (MRA). […] Arteriography remains the gold standard to RAS diagnosis, however with a degree of invasiveness which prevents it from becoming a screening tool. […] According to European Guidelines, DUS is recommended as the first-line imaging test to establish the diagnosis of RAS (class I, LOE B). […] CTA (in patients with creatinine clearance over 60 mL/min) is recommended to establish the diagnosis of RAS according to the European Guidelines on the management of peripheral artery disease (PAD) (class I, LOE B). […] Magnetic Resonance Angiography is recommended by the European Guidelines for the management of PAD (in patients with creatinine clearance 30 mL/min) to establish the diagnosis of RAS (Class I, LOE B).

• #1 Renal Artery Stenosis | Radiology Key

  https://radiologykey.com/renal-artery-stenosis/

  Renal artery stenosis, resulting in renovascular hypertension, is a major cause of secondary hypertension. […] The most common cause of renal artery stenosis is atherosclerotic, usually ostial, narrowing of the renal artery. […] Indications for treatment with renal artery catheter-based interventions must include renal artery stenosis documented to be hemodynamically significant, particularly when associated with renal dysfunction, poorly controlled hypertension, or recurrent pulmonary edema. […] Catheter-based angiography is the gold standard for diagnosing significant renal artery stenosis. […] The anatomic minimum threshold of hemodynamically significant renal artery stenosis is greater than 70-80 % diameter. […] Hemodynamically significant stenoses include lesions with a peak systolic gradient of greater than 10-20 mmHg or 10 % of the peak systolic pressure.

• #1 Radiologic Evaluation of Suspected Renovascular Hypertension | AAFP

  https://www.aafp.org/pubs/afp/issues/2009/0801/p273.html

  Diagnostic imaging tests for suspected renovascular hypertension depend on the index of suspicion for renovascular disease and on the patient’s renal function. If clinical findings strongly suggest the possibility of renovascular disease, contrast-enhanced magnetic resonance angiography or computed tomographic angiography should be performed. […] Captopril renography is also adequate in these patients if magnetic resonance angiography and computed tomographic angiography are not desired or are contraindicated. […] When renal artery stenosis is suspected and diagnosed, it is debatable about which patients will benefit from revascularization.

• #1 Diagnosis and treatment of renal artery stenosis | Nature Reviews Nephrology

  https://www.nature.com/articles/nrneph.2009.230

  A reduction in the diameter of the renal arteries can lead to hypertension, renal dysfunction and/or pulmonary edema. […] Atherosclerotic renal artery stenosis is a common condition that typically occurs in patients at high risk of cardiovascular disease with coexistent vascular disease at nonrenal sites. […] Patients who undergo revascularization to treat hypertension associated with atherosclerotic stenosis need to continue medication with statins, antiplatelet agents and reninangiotensin antagonists after the procedure to prevent renal and cardiovascular events. […] Available results favor a conservative approach (medication only) for most patients with atherosclerotic renal artery stenosis. […] Blood pressure outcome after angioplasty is more favorable in patients with fibromuscular renal artery disease, who usually do not have renal failure, than in those with atherosclerosis.

• #2 Renal Artery Stenosis: Practice Essentials, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/245023-overview

  Renal artery stenosis (RAS) is the major cause of renovascular hypertension and may account for 1-10% of the 50 million cases of hypertension in the United States population. […] Apart from its role in the pathogenesis of hypertension, renal artery stenosis is also increasingly recognized as an important cause of chronic kidney insufficiency and end-stage kidney disease. […] The workup in a patient with possible renal artery stenosis includes laboratory studies of kidney function and imaging studies of the kidneys and renal circulation. […] Guidelines covering the diagnosis and medical and surgical therapy of renal artery stenosis have been published. […] In patients with renal artery stenosis, the GFR is dependent on angiotensin II and other modulators that maintain the autoregulation system between the afferent and efferent arteries and can fail to maintain the GFR when renal perfusion pressure drops below 70-85 mm Hg.

• #2 Diagnosing Renal Artery Stenosis | NYU Langone Health

  https://nyulangone.org/conditions/renal-artery-stenosis/diagnosis

  NYU Langone doctors are experts at diagnosing renal artery stenosis. The condition results from a narrowing of one or both renal arteries, the blood vessels that lead to the kidneys. […] Your NYU Langone cardiologist may suspect renal artery stenosis if you’re middle-aged and medications have failed to lower your high blood pressure. […] First, the doctor conducts a physical examination to look for symptoms such as swelling in the ankles. He or she also checks your blood pressure and takes a medical history to assess your health. Your doctor may order one or more of the following tests. […] If your doctor suspects you have renal artery stenosis, he or she may order a Doppler ultrasound to view blood flow in the renal arteries. The test allows doctors to assess plaque buildup and identify narrowing of the arteries.

• #2 Renal artery stenosis – Symptoms, diagnosis and treatment | BMJ Best Practice

  https://bestpractice.bmj.com/topics/en-gb/435

  aldosterone-to-renin ratio. […] Investigations to consider […] duplex ultrasound […] gadolinium-enhanced MR angiography (MRA) […] CT angiography […] conventional angiography […] carbon dioxide (CO2) angiography […] non-contrast magnetic resonance angiography […] captopril radionuclide renal scan.

• #2 Renal Artery Stenosis

  https://www.nephrologyspecialistsoftulsa.com/renal-artery-stenosis.php

  RAS is diagnosed through a physical examination and a review of symptoms. […] Blood and urine tests may be performed to check cholesterol and creatinine levels, and evaluate kidney function. […] Additional diagnostic tests include the following: […] RAS may be discovered when a person is being tested for other conditions, such as heart problems. […] RAS may be detected during a coronary angiogram, which is a test that is used to evaluate blood flow through the heart.

• #2 Renal Artery Stenosis Workup: Laboratory Studies, Imaging Studies

  https://emedicine.medscape.com/article/245023-workup

  Obtain serum creatinine levels to assess the level of kidney dysfunction. […] Studies designed to assess the renin-angiotensin system are of little diagnostic utility in patients with atherosclerotic renovascular disease (RVD). […] Renal ultrasonography scanning is performed frequently in patients with kidney dysfunction. […] Duplex ultrasonographic scanning combines a B-mode ultrasonographic image with a pulse Doppler unit to obtain flow velocity data. […] Radermacher et al reported that the renal resistance index, calculated through the use of color Doppler ultrasonography, can be used to predict the outcome of invasive therapy for renal artery stenosis. […] Use of radionuclide scanning, particularly following a single dose of captopril, is more useful in patients with normal kidney function, in whom fibromuscular disease is suspected.

• #2 Renal Artery Stenosis: Symptoms, Diagnosis and Therapy

  http://www.urology-textbook.com/renal-artery-stenosis.html

  Elevated renin concentration (80% sensitivity and specificity if antihypertensive medication was paused). […] Renal Doppler sonography misses the diagnosis (false negative) in 10-20%. […] A PSV of 180 cm/s and an EDV of 80 cm/s speak in favor of renal artery stenosis. […] A reno-aortic ratio (RAR) 3.5 is typical for renal artery stenosis (if a normal flow in the aorta is present). […] An RI below 0.5 indicates significant renal artery stenosis, but this is not sufficient as the sole diagnostic criterion. […] The test has a 90% sensitivity and specificity for the presence of a hemodynamically significant renal artery stenosis. […] Invasive angiography is the gold standard of renal artery stenosis imaging. […] Renal biopsy reveals the extent of ischemic renal damage due to renal artery stenosis and may predict the therapeutic success of revascularization.

• #2 Renal Artery Stenosis Workup: Laboratory Studies, Imaging Studies

  https://emedicine.medscape.com/article/245023-workup

  Spiral CT angiography is a useful technique that avoids arterial catheterization and produces accurate images of renal artery anatomy. […] Magnetic resonance angiography (MRA) is a noninvasive technique capable of demonstrating the renal vascular anatomy and revealing physiologic information about kidney function. […] The limitations of MRA are its expense and its contraindication in patients with metallic clips, pacemakers, intraocular metallic devices, or other implants. […] Conventional aortography produces excellent radiographic images of the renal artery, but it requires an arterial puncture, carries the risk of cholesterol emboli, and uses a moderate amount of contrast material with the risk of contrast-induced acute tubular necrosis (ATN). […] Patients with progressive ischemic nephropathy (ie, underlying chronic kidney disease) are at risk for contrast nephrotoxicity and should be informed of this risk prior to any contrast procedure.

• #2 Renal artery stenosis – Knowledge @ AMBOSS

  https://www.amboss.com/us/knowledge/renal-artery-stenosis/

  Imaging is required to confirm a clinical suspicion of renal artery stenosis. Laboratory findings may provide supportive evidence but are not diagnostic. […] A high pretest probability for renal artery stenosis, as determined by the presence of 1 of the following features. […] The choice of modality depends on the presence and severity of renal dysfunction. Consider a nephrology and/or radiology consult in patients with significant renal dysfunction (eGFR 2) to help guide this decision. […] First-line (screening) tests […] Second-line test: catheter angiography (diagnostic gold standard) […] In patients with renal dysfunction, there is a risk of contrast-induced nephropathy with CT/catheter angiography and a risk of nephrogenic systemic fibrosis with MR angiography with gadolinium contrast. […] Patients with hemodynamically significant renal artery stenosis may require revascularization procedures to control hypertension.

• #2 Renal artery stenosis – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/renal-artery-stenosis/diagnosis-treatment/drc-20352782

  For diagnosis of renal artery stenosis, your health care provider may start with: […] Imaging tests commonly done to diagnose renal artery stenosis include: […] Doppler ultrasound. High-frequency sound waves help your doctor see the arteries and kidneys and check their function. […] CT scan. During a CT scan, an X-ray machine linked to a computer creates a detailed image that shows cross-sectional images of the renal arteries. […] Magnetic resonance angiography (MRA). MRA uses radio waves and strong magnetic fields to produce detailed 3D images of the renal arteries and kidneys. […] Renal arteriography. This special type of X-ray exam helps your doctor find the blockage in the renal arteries and sometimes open the narrowed part with a balloon or stent. […] For certain people a procedure may be recommended to restore blood flow through the renal artery to improve blood flow to the kidney.

• #2

  https://journals.lww.com/sjkd/fulltext/2022/33010/review_of_renal_artery_stenosis_and_hypertension_.16.aspx

  DSA is the gold standard for characterizing these lesions and is usually combined with endovascular procedures, including dilation and stent placement. […] The current options to treat ARAS-related HTN are either medical therapy alone or the same as revascularization (which may be an endovascular or open approach). […] If a critical decline (over 30%) in GFR is observed (or an upsurge in serum Cr level over 0.5 mg/dL), then revascularization may be inevitable. […] Endovascular intervention is still controversial and case-based, and the American Heart Association guidelines and the European Society of Cardiology guidelines are presented in (Table 2). […] The current European Society of Cardiology guidelines on the management of atherosclerotic lesions, direct that if a patient is planned for angioplasty, stenting is advocated for ostial ARAS (Class I, level of evidence B).

• #2 Renal artery stenosis | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/renal-artery-stenosis?lang=us

  Renal artery stenosis (RAS) (plural: stenoses) refers to a narrowing of a renal artery. When the process occurs slowly, it leads to secondary hypertension. Acute renal artery stenosis does not lead to hypersecretion of renin. […] Ultrasound, although most freely available, cheap and often used first-line, is relatively operator-dependent and may prove time-consuming. […] The three-dimensional reconstruction of the renal vascular tree provides a reliable method of visualizing the entire vascular tree. […] Reported sensitivity and specificity for MR angiography is at around 95%; 90% for detection of stenoses of 50% or greater in diameter. MR angiography may overestimate moderate stenosis and detection/evaluation of multiple and branch arteries can at times be problematic. […] the affected kidney with renovascular hypertension shows impaired function due to ACE inhibition; based on this principle scintigraphy has been very much useful for the diagnosis of renal artery stenosis.

• #2 Diagnosis and Management of Atherosclerotic Renal Artery Stenosis

  https://www.medscape.org/viewarticle/588519_4

  The indications for screening angiography for RAS at the time of cardiac or peripheral angiography of other vascular beds were addressed by AHA and ACC recommendations and guidelines published in 2006. […] A visually estimated stenosis of 70% or greater is considered hemodynamically significant, and is a generally accepted indication for percutaneous intervention. […] The relief of hemodynamic obstruction (translesional pressure gradient) without injury to the renal parenchyma, rather than the cosmetic improvement of angiographic stenosis, is the ultimate goal of RAS reperfusion. An expert consensus panel of the AHA recommended that a peak systolic gradient of at least 20 mmHg, or a mean pressure gradient of 10 mmHg, be used to identify candidate lesions for revascularization in symptomatic patients with RAS. […] Another method to determine the severity of angiographic RAS is to quantify the fractional flow reserve (FFR).

• #2 Renal Artery Stenosis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK430718/

  Renal artery stenosis is narrowing of the one or both of renal arteries. It is the major cause of hypertension and according to some reports is the cause of hypertension in 1% to 10% of the 50 million people in the United States. […] This activity reviews the cause, pathophysiology, and presentation of renal artery stenosis and highlights the role of the interprofessional team in its management. […] Describe the evaluation of a patient with renal artery stenosis. […] The gold standard for diagnosing renal artery stenosis is renal arteriography. However, a variety of less invasive tests are being employed for evaluation for testing purposes. […] The choice of test should be based upon institutional expertise and patient factors. […] If the noninvasive test is inconclusive and the clinical suspicion remains high, conventional renal arteriography is recommended.

• #2 Renal Artery Stenosis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK430718/

  Duplex Doppler ultrasonography is a noninvasive, relatively inexpensive technique that can be used in patients with any level of renal function. […] The first approach involves direct scanning of the main renal arteries with color or power Doppler US followed by spectral analysis of renal artery flow using an anterior or anterolateral approach. […] The presence of an early systolic peak can be interpreted as a sign of normality; however, the absence of an early systolic peak is not necessarily indicative of stenosis. […] The degree of renal artery stenosis that would justify any intervention attempt is greater than 80% in patients with bilateral stenosis or stenosis in a solitary functioning kidney regardless of whether they have renal insufficiency or not. […] When renal function is normal or nearly normal, revascularization is recommended for prevention of renal insufficiency if the patient fulfills the mentioned criteria. […] When renal function abnormality is present, the criteria for revascularization are as follows: The degree of stenosis is higher than 80%.

• #2 Renal Artery Stenosis | Radiology Key

  https://radiologykey.com/renal-artery-stenosis/

  Renal artery stenosis, resulting in renovascular hypertension, is a major cause of secondary hypertension. […] The most common cause of renal artery stenosis is atherosclerotic, usually ostial, narrowing of the renal artery. […] Indications for treatment with renal artery catheter-based interventions must include renal artery stenosis documented to be hemodynamically significant, particularly when associated with renal dysfunction, poorly controlled hypertension, or recurrent pulmonary edema. […] Catheter-based angiography is the gold standard for diagnosing significant renal artery stenosis. […] The anatomic minimum threshold of hemodynamically significant renal artery stenosis is greater than 70-80 % diameter. […] Hemodynamically significant stenoses include lesions with a peak systolic gradient of greater than 10-20 mmHg or 10 % of the peak systolic pressure.

• #2 How to manage renovascular hypertension

  https://www.escardio.org/Journals/E-Journal-of-Cardiology-Practice/Volume-13/How-to-manage-renovascular-hypertension

  Useful noninvasive tools frequently used in clinical practice are: duplex ultrasonography (DUS), CT angiography (CTA) and MR angiography (MRA). […] Arteriography remains the gold standard to RAS diagnosis, however with a degree of invasiveness which prevents it from becoming a screening tool. […] According to European Guidelines, DUS is recommended as the first-line imaging test to establish the diagnosis of RAS (class I, LOE B). […] CTA (in patients with creatinine clearance over 60 mL/min) is recommended to establish the diagnosis of RAS according to the European Guidelines on the management of peripheral artery disease (PAD) (class I, LOE B). […] Magnetic Resonance Angiography is recommended by the European Guidelines for the management of PAD (in patients with creatinine clearance 30 mL/min) to establish the diagnosis of RAS (Class I, LOE B).

• #2 Diagnosis and treatment of renal artery stenosis | Nature Reviews Nephrology

  https://www.nature.com/articles/nrneph.2009.230

  A reduction in the diameter of the renal arteries can lead to hypertension, renal dysfunction and/or pulmonary edema. […] Atherosclerotic renal artery stenosis is a common condition that typically occurs in patients at high risk of cardiovascular disease with coexistent vascular disease at nonrenal sites. […] Patients who undergo revascularization to treat hypertension associated with atherosclerotic stenosis need to continue medication with statins, antiplatelet agents and reninangiotensin antagonists after the procedure to prevent renal and cardiovascular events. […] Available results favor a conservative approach (medication only) for most patients with atherosclerotic renal artery stenosis. […] Blood pressure outcome after angioplasty is more favorable in patients with fibromuscular renal artery disease, who usually do not have renal failure, than in those with atherosclerosis.

• #3 Renal artery stenosis – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/renal-artery-stenosis/symptoms-causes/syc-20352777

  As renal artery stenosis progresses, other signs and symptoms may include: High blood pressure that’s hard to control; A whooshing sound as blood flows through a narrowed vessel (bruit), which your doctor hears through a stethoscope placed over your kidneys; Elevated protein levels in the urine or other signs of a problem with kidney function; Worsening kidney function during treatment for high blood pressure; Fluid overload and swelling in your body’s tissues; Treatment-resistant heart failure. […] The two main causes of renal artery stenosis include: Buildup on kidney (renal) arteries. Fats, cholesterol and other substances (plaque) can build up in and on your kidney artery walls (atherosclerosis). […] Atherosclerosis occurs in many areas of the body and is the most common cause of renal artery stenosis.

• #3

  https://journals.lww.com/sjkd/fulltext/2022/33010/review_of_renal_artery_stenosis_and_hypertension_.16.aspx

  Renal artery stenosis is one of the most common causes of secondary hypertension (HTN). […] Renal artery stenosis can be diagnosed using multiple modalities, including Duplex, computed tomography angiography, magnetic resonance angiography, or selective angiogram. […] Given the insidious onset of RAS, clinicians struggle to diagnose and treat it for three reasons. […] Accurate RAS diagnosis requires extensive and, occasionally, invasive measures. […] Duplex demonstrated a sensitivity of 89%, specificity of 69%, and negative predictive value of 95% for spotting a significant RAS. […] CTA is an invasive method with high-resolution cross-sectional imaging, which can be subsequently used to reconstruct 3-dimensional angiographic images of the renal and visceral arteries and aorta. […] This investigation can localize and enumerate the lesions of the renal arteries and characterize the stenosis.

• #3 Renal artery stenosis – how do we confirm the diagnosis? – GP Voice

  https://gpvoice.com.au/index.php/2023/12/12/renal-artery-stenosis-how-do-we-confirm-the-diagnosis/

  The most common imaging studies utilised to evaluate the presence of RAS are duplex ultrasonography, computed tomographic angiography (CTA) and magnetic resonance angiography (MRA). […] A CT renal angiogram is a well-established minimally invasive diagnostic procedure for assessment of suspected RAS. This test involves the administration of intravenous contrast and acquiring detailed images to visualise the renal arteries, surrounding blood vessels and anatomical structures. This procedure is widely used for assessment of RAS because of its ease of availability, rapid acquisition, reproducibility, non-operator dependent and increased spatial resolution. With high sensitivity (90% to 98%) and specificity (85% to 94%) in addition to aforementioned benefits, CT renal angiography is a valuable tool for diagnosing renal artery stenosis and can be performed in conjunction with a renal arterial doppler study.

• #3 Renal artery stenosis | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/renal-artery-stenosis?lang=us

  Renal artery stenosis (RAS) (plural: stenoses) refers to a narrowing of a renal artery. When the process occurs slowly, it leads to secondary hypertension. Acute renal artery stenosis does not lead to hypersecretion of renin. […] Ultrasound, although most freely available, cheap and often used first-line, is relatively operator-dependent and may prove time-consuming. […] The three-dimensional reconstruction of the renal vascular tree provides a reliable method of visualizing the entire vascular tree. […] Reported sensitivity and specificity for MR angiography is at around 95%; 90% for detection of stenoses of 50% or greater in diameter. MR angiography may overestimate moderate stenosis and detection/evaluation of multiple and branch arteries can at times be problematic. […] the affected kidney with renovascular hypertension shows impaired function due to ACE inhibition; based on this principle scintigraphy has been very much useful for the diagnosis of renal artery stenosis.

• #3 Diagnosing Renal Vascular Disease | Stanford Health Care

  https://stanfordhealthcare.org/medical-conditions/blood-heart-circulation/renal-vascular-disease/diagnosis.html

  This test uses a magnetic field and pulses of radio wave energy to make pictures of the renal arteries. It can show narrowing in the renal arteries that may be causing reduced blood flow. This test allows the doctor to see both the blood flow and the condition of the artery walls. […] A catheter angiogram of the kidney. […] This is an X-ray test that provides pictures of the blood flow in a blood vessel, such as the renal arteries. During an angiogram, the doctor will put a thin, flexible tube into a blood vessel in your groin or arm. This tube is called a catheter. The doctor guides the tube to the blood vessel that will be studied. Then a dye is injected through the tube to make the area easier to see. X-rays or pictures are taken of the area. An angiogram can also show narrowing or a blockage in a blood vessel that affects blood flow. Sometimes a problem can be treated during this test. For example, a catheter can be used to open a narrowed renal artery.

• #3 How to manage renovascular hypertension

  https://www.escardio.org/Journals/E-Journal-of-Cardiology-Practice/Volume-13/How-to-manage-renovascular-hypertension

  Renal angiography is the gold standard for renal artery imaging. […] When the clinical index of suspicion is high and the results of non-invasive tests are inconclusive, digital subtraction angiography is recommended as a diagnostic test (prepared for intervention) to establish the diagnosis of RAS (class I, LOE C). […] According to the latest ESC Guidelines on the management of PAD, Captopril renal scintigraphy, selective renal vein renin measurements, plasma renin activity, and the captopril test are not recommended as useful screening tests to establish the diagnosis of RAS (class III, LOE B). […] The purpose of therapy in patients with renal artery disease is to control blood pressure and preserve renal function. […] If HTN control cannot be achieved or a decline in renal function is evident, revascularisation should be more strongly considered.

• #3 Diagnosis and Management of Atherosclerotic Renal Artery Stenosis

  https://www.medscape.org/viewarticle/588519_4

  The indications for screening angiography for RAS at the time of cardiac or peripheral angiography of other vascular beds were addressed by AHA and ACC recommendations and guidelines published in 2006. […] A visually estimated stenosis of 70% or greater is considered hemodynamically significant, and is a generally accepted indication for percutaneous intervention. […] The relief of hemodynamic obstruction (translesional pressure gradient) without injury to the renal parenchyma, rather than the cosmetic improvement of angiographic stenosis, is the ultimate goal of RAS reperfusion. An expert consensus panel of the AHA recommended that a peak systolic gradient of at least 20 mmHg, or a mean pressure gradient of 10 mmHg, be used to identify candidate lesions for revascularization in symptomatic patients with RAS. […] Another method to determine the severity of angiographic RAS is to quantify the fractional flow reserve (FFR).

• #3 Renal Artery Stenosis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK430718/

  Duplex Doppler ultrasonography is a noninvasive, relatively inexpensive technique that can be used in patients with any level of renal function. […] The first approach involves direct scanning of the main renal arteries with color or power Doppler US followed by spectral analysis of renal artery flow using an anterior or anterolateral approach. […] The presence of an early systolic peak can be interpreted as a sign of normality; however, the absence of an early systolic peak is not necessarily indicative of stenosis. […] The degree of renal artery stenosis that would justify any intervention attempt is greater than 80% in patients with bilateral stenosis or stenosis in a solitary functioning kidney regardless of whether they have renal insufficiency or not. […] When renal function is normal or nearly normal, revascularization is recommended for prevention of renal insufficiency if the patient fulfills the mentioned criteria. […] When renal function abnormality is present, the criteria for revascularization are as follows: The degree of stenosis is higher than 80%.

• #3 Diagnosis and treatment of renal artery stenosis | Nature Reviews Nephrology

  https://www.nature.com/articles/nrneph.2009.230

  Atherosclerotic renovascular disease is a cardiovascular condition that is associated with renal artery stenosis (RAS); treatment with statins and reninangiotensin antagonists can provide cardiovascular protection. […] Renal impairment associated with atherosclerotic RAS is both a marker and a risk factor for cardiovascular disease. […] Patients with atherosclerotic RAS and a stable condition should be treated first with medication. […] Renal artery stenting is not recommended for most patients with atherosclerotic RAS, but it might be beneficial for those with refractory hypertension or rapidly progressing renal or cardiac dysfunction. […] Plouin, P. F. Stable patients with atherosclerotic renal artery stenosis should be treated first with medical management.

• #4 Diagnosis and Management of Atherosclerotic Renal Artery Stenosis

  https://www.medscape.org/viewarticle/588519_4

  The resistance index, which is an adjunctive measure obtained during renal DUS, is the ratio of the peak systolic to end diastolic velocity within the renal parenchyma at the level of the cortical blood vessels. […] CTA is often used in patients who cannot be adequately imaged with DUS, such as very obese patients, or patients with excessive abdominal gas. […] Depending on the specific technique used, CTA has excellent sensitivity (89-100%) and specificity (82-100%) for detecting RAS. […] MRA, like CTA, provides excellent imaging of the abdominal vasculature and associated anatomical structures. […] A study by Silva et al. of 27 patients with poorly controlled hypertension and RAS (=70% stenosis), showed that BNP was elevated before stent placement and fell within 24 h of successful stent placement.

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