Renovascular Hypertension - Diagnosis and Presentation

Diagnosis and Presentation

Techniques have been developed to diagnose renal hypertension using digital image processing of radiographs. Treatment may involve angioplasty and stenting of the renal arteries. The syndrome may be related to other diseases of the epithelium.

Suggestive clinical features include onset of hypertension <30 or >50 years of age, abdominal or femoral bruits, hypokalemic alkalosis, moderate to severe retinopathy, acute onset of hypertension or malignant hypertension, and hypertension resistant to medical therapy.

The "gold standard" in diagnosis of renal artery stenosis is conventional arteriography. Magnetic resonance angiography (MRA) is used in many centers, especially among patients with renal insufficiency at higher risk for contrast nephropathy. MRA may overestimate the severity of stenosis relative to angiography. In patients with normal renal function and hypertension, the captopril (or enalaprilat) renogram may be used. Lateralization of renal function is suggestive of significant vascular disease. Test results may be falsely negative in the presence of bilateral disease.