hypertension- renal artery stenosis

My blood pressure has been up for several weeks, even with a week's worth of medication.  My doctor said that he may want to have tests done to see if I have renal artery stenosis.  I was just wondering what sort of tests are done to check for that.

[CCF-M.D.-RCJ]

srk2780,

Thanks for the question.  

The tests used to detect renal artery stenosis vary from institution to institution.  The three most commonly used tests are (1) ultrasound (called renal artery duplex), (2) MRI, and (3) angiography.  The accuracy of the first 2 studies depends on the hospital at which they are performed.  Angiography is readily reproducible from hospital to hospital and is "the gold standard"; however, it is invasive.  We usually reserve angiography for patients in whom we strongly suspect renal artery stenosis or in whom we have done either ultrasound or MRI with positive results.

One question to consider is whether or not knowing that you have renal artery stenosis would make any difference in your care.  Recommendations for whom should undergo intervention with angioplasty vary; some experts recommend intervention for the following groups: Patients below the age of 50 to 60 with new onset hypertension, patients with episodes of flash pulmonary edema, and patients who have severe, sudden onset hypertension, and either spontaneous or drug-induced renal insufficiency.  I have included a reference.

Hope that helps.

Ref:
The Effect of Balloon Angioplasty on Hypertension in Atherosclerotic Renal-Artery Stenosis
van Jaarsveld B. C., Krijnen P., Pieterman H., Derkx F. H.M., Deinum J., Postma C. T., Dees A., Woittiez A. J.J., Bartelink A. K.M., Man in `t Veld A. J., Schalekamp M. A.D.H., The Dutch Renal Artery Stenosis Intervention Cooperative Study Group
N Engl J Med 2000; 342:1007-1014, Apr 6, 2000.

[srk2780]

Thanks for the information.

In my case, the hypertension came really fast.  My BP was checked in early September, and it was in a low-normal range.  At mid-September I went to the doctor for an unrelated condition, and my BP was extremely high.  I have had it checked three times a week since then, and even after medication, it is still staying above the 140/90 mark.  

My hypertension is not related to diet or physical activity, and an initial round of lab work, an ECG, and x-rays don't show anything wrong. Because of my age (20) and the fact that my maternal grandparents and great-aunts suffered from hypertension and kidney problems, my doctor feels that renal artery stenosis might be a possible cause.

[Nania1947]

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