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Chapter 52. Renal Artery Angioplasty and Stenting

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A 52-year-old woman undergoes magnetic resonance angiography (MRA) of the abdomen for abdominal pain, which identifies a unilateral 80% left renal artery stenosis. She is referred to you for an opinion regarding treatment. The patient has normal renal function and a diagnosis of hypertension, which is well controlled on 2 medications. Which of the following is appropriate?

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A. Perform a renal ultrasound to obtain a baseline image and velocity.

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B. Perform an angiogram to confirm the MRA stenosis.

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C. Perform an angiogram with renal stenting.

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D. There is no need for renal stenting unless her blood pressure becomes uncontrolled.

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The correct answer is D

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There is no indication for revascularization of asymptomatic renal artery stenosis.

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A 72-year-old man with a known unilateral 70% renal artery stenosis and normal renal function is referred for further evaluation by his primary care physician. His blood pressure has ranged from 150/92 mm Hg to 165/88 mm Hg on his home blood pressure cuff over the past several weeks. He is taking a diuretic and an angiotensin-converting enzyme (ACE) inhibitor for his hypertension. In the office today, you measure his blood pressure at 138/86 mm Hg in both arms after 5 minutes of resting. Which of the following is appropriate?

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A. Add a β-blocker to his regimen.

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B. Add a calcium antagonist to his regimen.

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C. Repeat the ultrasound to look for progression of the lesion.

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D. Ask him to bring his home cuff into the clinic so that it can be checked against the clinic blood pressure cuffs.

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The correct answer is D

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There is no indication for intervention. It is important to resolve any systematic measurement differences on home equipment.

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An 82-year-old woman presents to the emergency department in acute heart failure manifested by pulmonary edema. She is managed with diuretics. Her blood pressure is 142/90 mm Hg on diuretics and a β-blocker. During her hospital stay, an abdominal ultrasound reveals a 60% to 99% unilateral right renal artery stenosis. Her renal function is mildly impaired with an estimated creatinine clearance of 62 mL/min. Which of the following is most appropriate?

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A. Perform an angiogram, and if an ischemic renal artery stenosis is confirmed, perform renal stenting.

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B. Add an ACE inhibitor.

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C. Add ...

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