Renal Artery Stenosis

I am a 32 year old white,nonsmoking, female (3 kids, 2 pregnancies).  I do not have hypertension.  During a pre-op (lap-chole) visit, the general surgeon noticed an abdominal bruit.  I followed up with an internist (also heard the bruit) who ordered an u/s of aorta, u/s of splenic artery and u/s of renals with doppler.

The u/s stated the aorta was fine, had no comment on the splenic artery and stated that there was a slight increase of velocity in the right renal artery.  I followed up with a vascular surgeon.  He ordered an MRA, which was done on Monday.  The results state normal renal arteries.  Again, there was no comment on the spleen.

Was an MRA the right test to diagnose renal artery stenosis because of fibromuscular dysplasia?  I have been reading on the net that an angiogram is the only positive way to diagnose RAS.  Why did I have an MRA?  Should I follow now with an angiogram?  How is FMD diagnosed?

Where should I go from here?  Is a bruit really sometimes just a bruit?  It seems to me if more than one person hears a bruit than that would point to something that needs to be fixed.

Thank you for your time and I would appreciate any comments/insights and suggestions.

Jennifer

[CCF-M.D.-CRC]

Dear Jennifer,

I think this is a case of everyone being cautious and one thing leading to another.  The risk of renal artery stenosis in a young person with normal blood pressure is very low to start with.  However given the physical exam findings your internist thought it best to make sure you did not have this and he ordered the ultrasound.  When that showed some increased velocity the surgeon ordered the MRA.  The good news is that the MRA is normal and if I were your doctor I would probably let that be that and do no additional testing.  A angiogram is the gold standard but it is an invasive test and one you probably don't need.  Bruits can be due to normal blood flow as well as due to stenosis. I would follow up with your internist now that all the tests results are back so you can discuss things and answer any lingering questions.