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Stable atherosclerotic renal artery stenosis — ESENeph MCQ

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ModerateHypertension and Renovascular DiseaseStable atherosclerotic renal artery stenosisESENeph

A 69-year-old man has bilateral atherosclerotic renal artery stenosis found during vascular work-up. Blood pressure is 136/78 mmHg on two drugs, eGFR is stable at 44 mL/min/1.73 m² and he has no pulmonary oedema. There is no rapid renal decline and potassium is 4.9 mmol/L. What is the most appropriate management?

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Correct answer: E — Optimise medical therapy and cardiovascular risk reduction

Stable atherosclerotic renal artery stenosis without flash pulmonary oedema, refractory hypertension or rapid renal decline is usually managed medically. Routine stenting has not shown broad benefit in unselected stable disease. Steroids and nephrectomy are not appropriate. The pearl is that selected high-risk phenotypes differ from incidental or stable renovascular disease.

Reference: KDIGO Blood Pressure Guideline; NICE NG203