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Renal artery stenosis — RCPSC IM MCQ

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HardNephrologyRenal artery stenosisRCPSC IM

A 71-year-old man has resistant hypertension, flash pulmonary edema twice in 3 months and a rise in creatinine after ACE inhibitor initiation. Duplex ultrasound suggests bilateral renal artery stenosis. He is adherent to three antihypertensive agents and a statin. What is the most appropriate management?

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Correct answer: A — Refer for specialist assessment for possible renal artery revascularisation plus intensive medical therapy

Most atherosclerotic renal artery stenosis is managed medically, but recurrent flash pulmonary edema, resistant hypertension and bilateral disease are high-risk features where revascularisation assessment is appropriate.

Reference: Hypertension Canada 2025 guideline; KDIGO renovascular disease practice