skip to main content

Renovascular Hypertension — ESENeph MCQ

Instant feedback + full explanation. One question, done properly.

ModerateHypertensionRenovascular HypertensionESENeph

A 40-year-old man presents with metabolic alkalosis (pH 7.52, bicarbonate 38 mmol/L), hypokalaemia (K+ 2.5 mmol/L), and hypertension (BP 170/100 mmHg). Renin is elevated and aldosterone is elevated. Renal artery Doppler shows >70% stenosis of the left renal artery. What is the most likely diagnosis?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: E — Renovascular hypertension with secondary hyperaldosteronism

Elevated renin with elevated aldosterone (secondary hyperaldosteronism) in the context of renal artery stenosis is diagnostic of renovascular hypertension. The stenosis activates the RAAS, causing aldosterone-mediated potassium wasting and metabolic alkalosis. In Conn syndrome (primary aldosteronism), renin is suppressed. In Liddle syndrome, both renin and aldosterone are suppressed. Management includes medical BP control (ACEi/ARB with monitoring for AKI) and consideration of angioplasty for fibromuscular dysplasia.

Reference: NICE NG136 2019 – Hypertension; ESC 2018 – Renovascular Disease