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Atherosclerotic renal artery stenosis — RCPSC IM MCQ

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HardNephrologyAtherosclerotic renal artery stenosisRCPSC IM

A 72-year-old woman has recurrent flash pulmonary oedema, refractory hypertension, and a creatinine rise from 92 to 168 micromol/L after starting an ACE inhibitor. Examination reveals an abdominal bruit and ultrasound shows a smaller right kidney. Urinalysis is bland. What is the most appropriate investigation?

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Correct answer: A — CT or MR angiography of the renal arteries

Recurrent flash pulmonary oedema, resistant hypertension, ACE inhibitor-associated creatinine rise, abdominal bruit, asymmetric kidneys, and bland urine suggest renovascular disease; vascular imaging is appropriate when intervention would be considered.

Reference: Hypertension Canada guidance; KDIGO CKD guidance