Atherosclerotic renal artery stenosis — ESENeph MCQ

Correct answer: D — Refer for specialist renal revascularisation assessment

The best answer is “Refer for specialist renal revascularisation assessment”. Most atherosclerotic renal artery stenosis is treated medically, but recurrent pulmonary oedema, rapidly declining GFR and bilateral disease are recognised high-risk syndromes in which specialist revascularisation evaluation is warranted. “Increase the ACE-inhibitor dose before reassessing kidney function” is less appropriate because the large creatinine rise in bilateral disease signals haemodynamic risk and needs urgent review “Treat with glucocorticoids for presumed vascular inflammation” is less appropriate because the presentation is atherosclerotic renovascular disease rather than vasculitis “Start maintenance dialysis without assessing the renovascular lesion” is less appropriate because kidney replacement therapy is not the first response to a potentially treatable high-risk phenotype “Continue routine medical follow-up without specialist referral” is less appropriate because recurrent pulmonary oedema and bilateral functional loss distinguish this patient from stable incidental stenosis

Reference: Renovascular revascularisation scientific statement on renovascular revascularisation: https://pmc.ncbi.nlm.nih.gov/articles/PMC11731842/