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Renal Artery Stenosis — RACP Adult Medicine MCQ

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ModerateNephrologyRenal Artery StenosisRACP Adult Medicine

A 55-year-old woman with resistant hypertension and CKD has a renal artery bruit on examination. MRA shows >70% stenosis of the right renal artery with a small right kidney (8 cm) and normal left kidney (12 cm). She has atherosclerotic disease elsewhere (carotid plaques, PVD). What is the most likely cause?

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Correct answer: B — Renal artery stenosis

Resistant hypertension with renal artery bruit, asymmetric kidneys, and atherosclerotic disease is atherosclerotic renal artery stenosis. However, ASTRAL and CORAL trials showed NO benefit of renal artery stenting over medical therapy alone for atherosclerotic RAS. Treatment is optimal medical therapy: RAAS inhibition (with monitoring for AKI/hyperkalaemia), statins, and antiplatelet therapy. Stenting is reserved for: flash pulmonary oedema, rapidly declining renal function, or failure of medical therapy.

Reference: NHFA – 2016 – Hypertension; CORAL Trial; ESC 2024