Investigating progressive unexplained renal impairment and hypertension

doi:10.1136/bmj.39363.672743.AD

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 articleexplores 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 elderlypeople presenting with renal impairment and hypertension

•Ultrasonography is the first line method of imaging as it issafe, inexpensive, and widely available and readily detectsobstructive causes. However, a normal renal ultrasound studydoes not exclude the diagnosis of renal artery stenosis

•Magnetic resonance angiography and computed tomography angiographyare the preferred non-invasive imaging methods to identify renalartery stenosis. Digital subtraction angiography should be reservedfor patients in whom endovascular intervention is being consideredor when non-invasive imaging is inconclusive

The patient

A 79 year old hypertensive man was referred for investigationof impaired renal function. At the time of referral he was takinga single antihypertensive agent and his blood pressure measured170/85 mm Hg. He smoked 50 g of pipe tobacco a week. He hadno other medical history of note. No renal artery bruit was. . . [Full text of this article]

What is the next investigation?

Ultrasonography
Nuclear medicine
Computed tomography angiography
Magnetic resonance angiography
Digital subtraction angiography

Outcome

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