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Renal artery stenosis flash pulmonary edema — ABIM Board MCQ

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HardNephrologyRenal artery stenosis flash pulmonary edemaABIM Board

A 74-year-old man has recurrent flash pulmonary edema, resistant hypertension and an abdominal bruit. Creatinine increased from 1.8 to 3.0 mg/dL after losartan; current eGFR is 20 mL/min/1.73 m². Which initial noninvasive study best evaluates the suspected vascular cause while avoiding iodinated and gadolinium contrast?

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Correct answer: E — Obtain duplex Doppler ultrasonography to assess both renal arteries

The best answer is “Obtain duplex Doppler ultrasonography to assess both renal arteries”. The presentation raises concern for hemodynamically important renal artery stenosis, and duplex ultrasound evaluates renal artery velocities without nephrotoxic contrast. CTA and gadolinium-enhanced MRA carry important contrast concerns at this kidney function, renography performs poorly in advanced CKD, and noncontrast CT does not define arterial luminal stenosis.

Reference: AHA Scientific Statement: Revascularization for Renovascular Disease: https://pmc.ncbi.nlm.nih.gov/articles/PMC11731842/