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Atherosclerotic renal artery stenosis — RACP Adult Medicine MCQ

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HardNephrologyAtherosclerotic renal artery stenosisRACP Adult Medicine

A 73-year-old man has resistant hypertension and recurrent flash pulmonary oedema. Creatinine rose substantially after starting an ACE inhibitor. He has a femoral bruit and widespread vascular disease. What is the most appropriate investigation?

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Correct answer: E — CT or MR renal angiography after assessing renal function and contrast risk

Resistant hypertension, flash pulmonary oedema and ACE inhibitor-associated creatinine rise suggest renovascular disease, assessed with renal artery imaging. Urine microscopy alone does not evaluate arterial stenosis. Water deprivation, renal biopsy and catecholamines target different diagnoses.

Reference: Kidney Health Australia/CARI Guidelines; AMH