Open AccessThe Diagnosis and Management of Renovascular Disease: A Primary Care Perspective
Author(s) -
Bloch Michael J.,
Basile Jan
Publication year - 2003
Publication title -
the journal of clinical hypertension
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.909
H-Index - 67
eISSN - 1751-7176
pISSN - 1524-6175
DOI - 10.1111/j.1524-6175.2003.01766.x
Subject(s) - medicine , fibromuscular dysplasia , renovascular hypertension , asymptomatic , renal artery stenosis , gold standard (test) , stenosis , intensive care medicine , radiology , disease , renal artery obstruction , angiography , renal artery , kidney , blood pressure
Renovascular disease is a complex disorder, the most common causes of which are fibromuscular dysplasia and atherosclerotic disease. It usually presents in one of three forms: asymptomatic renal artery stenosis, renovascular hypertension, or ischemic nephropathy. This complexity often makes diagnostic and management decisions difficult. This review will be presented in two parts. In Part I, the authors will discuss when to consider and how to go about making the diagnosis. In Part II (in a future issue of The JCH ), the authors discuss the management of renovascular disease. The clinical index of suspicion remains paramount in setting the diagnostic strategy. Although it is subject to certain limitations, conventional contrast angiography is usually considered the gold standard in confirming the diagnosis. In addition, there are a number of available noninvasive tests that can aid in decision making. These tests can be divided into those that detect the anatomic presence of a stenosis and those that identify the functional consequences of the renal artery obstruction.No one study is appropriate for every patient. A diagnostic algorithm is proposed at the conclusion of this review.