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Renal Artery Stenosis Diagnosis — EECC MCQ

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ModerateHypertension & Preventive CardiologyRenal Artery Stenosis DiagnosisEECC

A 42-year-old man with hypertension and a recent TIA is found to have asymmetric renal size on ultrasound (right kidney 9 cm, left 12 cm). Duplex ultrasound shows a peak systolic velocity of 320 cm/s in the right renal artery (normal <200 cm/s). What is the most likely diagnosis?

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Correct answer: A — Renal artery stenosis — most likely atherosclerotic given hypertension and TIA; fibromuscular dysplasia should be considered given age

Asymmetric renal size with elevated renal artery peak systolic velocity (>200 cm/s, or renal-to-aortic ratio >3.5) on duplex ultrasound is diagnostic of renal artery stenosis. In a 42-year-old, both atherosclerotic RAS and fibromuscular dysplasia (FMD) should be considered. FMD typically affects young-to-middle-aged women, causing a 'string-of-beads' appearance on angiography, and responds well to percutaneous transluminal renal angioplasty (PTRA) without stenting. Atherosclerotic RAS is more common overall and presents with resistant hypertension. CT/MR angiography should be performed to characterise the stenosis. The ESC 2024 Hypertension Guidelines recommend screening for secondary causes in young hypertensives or those with resistant hypertension.

Reference: ESC (2024): Hypertension Guidelines; ESC (2024): Peripheral Arterial Disease Guidelines