Sections View Full Chapter Figures Tables Videos Full Chapter Figures Tables Videos Supplementary Content +++ KEY FEATURES +++ ESSENTIALS OF DIAGNOSIS ++ Age 30 or after age 55 Abdominal or flank systolic and diastolic bruits, or evidence of peripheral vascular disease Unilateral small kidney on any imaging study Hypertension resistant to 3 medications Worsening renal function after an angiotensin-converting enzyme inhibitor Elevated plasma renin activity with or without captopril administration Imaging evidence of renal artery occlusive disease +++ GENERAL CONSIDERATIONS ++ Renal vascular disease is an unusual cause of hypertension but is potentially curable Renal vascular hypertension usually results from obstruction of 1 main artery in 1 kidney The most common cause in women < age 30 is fibromuscular hyperplasia The most common cause in men > age 55 is atherosclerosis +++ CLINICAL PRESENTATION +++ SYMPTOMS AND SIGNS ++ No specific symptoms or signs +++ PHYSICAL EXAM FINDINGS ++ Advanced eye fundoscopic changes are common Renal bruits may be heard Evidence of other vascular disease +++ DIFFERENTIAL DIAGNOSIS ++ Essential hypertension Renal parenchymal disease Other causes of secondary hypertension +++ DIAGNOSTIC EVALUATION +++ LABORATORY TESTS ++ High plasma renin activity and plasma aldosterone levels +++ ELECTROCARDIOGRAPHY ++ Left heart chamber enlargement may be seen +++ IMAGING STUDIES ++ CT or magnetic resonance angiography of the renal arteries +++ DIAGNOSTIC PROCEDURES ++ Renal arteriogram is almost always diagnostic and can be followed by stenting if appropriate +++ TREATMENT +++ CARDIOLOGY REFERRAL ++ Refractory hypertension Suspected cardiac disease Planned renal artery stenting +++ HOSPITALIZATION CRITERIA ++ Complications of hypertension Planned procedure +++ MEDICATIONS ++ Pharmacologic therapy if hypertension is mild or readily controlled +++ THERAPEUTIC PROCEDURES ++ Percutaneous angioplasty with or without stenting +++ SURGERY ++ Surgical repair or nephrectomy +++ MONITORING ++ Blood pressure ECG in hospital as appropriate +++ DIET AND ACTIVITY ++ Low-sodium diet, limited alcohol intake Exercise as tolerated +++ ONGOING MANAGEMENT +++ HOSPITAL DISCHARGE CRITERIA ++ Resolution of problem Definitive procedure or surgery +++ FOLLOW-UP ++ One month, then 3 months, 6 months, yearly after procedure or surgery +++ COMPLICATIONS ++ Acute pulmonary edema Rapid decline in renal function Accelerated or malignant hypertension Restenosis can occur after angioplasty or stenting Persistent hypertension may occur after successful relief of arterial obstruction +++ PROGNOSIS ++... GET ACCESS TO THIS RESOURCE Sign In Username Error: Please enter User Name Password Error: Please enter Password Forgot Username? Forgot Password? Sign in via OpenAthens Sign in via Shibboleth Get Free Access Through Your Institution Contact your institution's library to ask if they subscribe to McGraw-Hill Medical Products. Access My Subscription GET ACCESS TO THIS RESOURCE Subscription Options Pay Per View Timed Access to all of AccessCardiology 24 Hour $34.95 (USD) Buy Now 48 Hour $54.95 (USD) Buy Now Best Value AccessCardiology Full Site: One-Year Individual Subscription $595 USD Buy Now View All Subscription Options