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Atherosclerotic renal artery stenosis — USMLE Step 3 MCQ

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HardInternal Medicine (chronic management)Atherosclerotic renal artery stenosisUSMLE Step 3

A 63-year-old woman has resistant hypertension and worsening kidney function after starting lisinopril. Creatinine rose from 1.0 to 1.8 mg/dL. She has recurrent flash pulmonary edema, an abdominal bruit, and asymmetric kidneys on ultrasound. Which of the following is the most appropriate at this time?

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Correct answer: C — Evaluate for renal artery stenosis

A marked creatinine rise after ACE inhibitor initiation, recurrent flash pulmonary edema, abdominal bruit, and asymmetric kidneys suggest renovascular disease. Evaluation for renal artery stenosis is appropriate.

Reference: ACC/AHA hypertension guidance