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Renovascular disease after ACE inhibitor — ESENeph MCQ

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HardHypertension and Renovascular DiseaseRenovascular disease after ACE inhibitorESENeph

A 67-year-old man starts ramipril for proteinuric CKD and hypertension. Creatinine rises from 126 to 178 micromol/L within 10 days and potassium is 5.6 mmol/L. He has an abdominal bruit and long-standing peripheral arterial disease. What is the most appropriate investigation?

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Correct answer: B — Renal artery imaging for renovascular disease

A creatinine rise above 30% after ACE inhibitor initiation, especially with vascular disease and bruit, should prompt assessment for renovascular disease or other haemodynamic factors. Renal biopsy is not the first investigation for this vascular presentation. The rise is larger than the usual acceptable haemodynamic effect. The pearl is that ACE inhibitors can reveal bilateral renal artery stenosis or stenosis to a solitary functioning kidney.

Reference: NICE NG203; KDIGO Blood Pressure Guideline