BMJ  2007;335:1094-1096 (24 November), doi:10.1136/bmj.39363.672743.AD

Practice

Rational Imaging

Investigating progressive unexplained renal impairment and hypertension

L A Ratnam, interventional radiology fellow, S R Nelson, consultant nephrologist, A M Belli, consultant interventional radiologist

Radiology Department, St George's Hospital, London SW17 0QT

Correspondence to: A M Belli Anna.Belli@stgeorges.nhs.uk

Diagnosing renal artery stenosis can be difficult. This article explores possible types of imaging for this, ranging from safe, inexpensive tests to more invasive procedures

The first 150 words of the full text of this article appear below.

Introduction


Learning points

• Renal artery stenosis is a common condition in elderly people presenting with renal impairment and hypertension
• Ultrasonography is the first line method of imaging as it is safe, inexpensive, and widely available and readily detects obstructive causes. However, a normal renal ultrasound study does not exclude the diagnosis of renal artery stenosis
• Magnetic resonance angiography and computed tomography angiography are the preferred non-invasive imaging methods to identify renal artery stenosis. Digital subtraction angiography should be reserved for patients in whom endovascular intervention is being considered or when non-invasive imaging is inconclusive


The patient

A 79 year old hypertensive man was referred for investigation of impaired renal function. At the time of referral he was taking a single antihypertensive agent and his blood pressure measured 170/85 mm Hg. He smoked 50 g of pipe tobacco a week. He had no other medical history of note. No renal artery bruit was . . . [Full text of this article]

What is the next investigation?

Outcome


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Rapid Responses:

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benefits of angioplasty remain uncertian
David Ansell
bmj.com, 29 Nov 2007 [Full text]
Wrong messages re investigation of renal artery stenosis
Peter A Andrews
bmj.com, 30 Nov 2007 [Full text]
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