Establishing the diagnosis of renovascular hypertension
- Stephen Textor, MD
Stephen Textor, MD
- Professor of Medicine
- Division of Nephrology and Hypertension
- Mayo Clinic College of Medicine
- Rochester, Minnesota
- Section Editors
- George L Bakris, MD
George L Bakris, MD
- Editor-in-Chief — Nephrology
- Section Editor — Hypertension
- Professor of Medicine
- The University of Chicago
- Norman M Kaplan, MD
Norman M Kaplan, MD
- Editor-in-Chief — Nephrology
- Section Editor — Hypertension
- Clinical Professor of Internal Medicine
- University of Texas Southwestern Medical Center
Renovascular disease is an important, potentially correctable cause of secondary hypertension. The frequency with which it occurs is variable. It accounts for less than 1 percent of cases of mild to moderate elevations in blood pressure . By contrast, the prevalence is much higher in patients with acute (even if superimposed upon a preexisting elevation in blood pressure), severe, or refractory hypertension .
The indications for testing, methods of testing, and interpretation of diagnostic tests for renovascular disease will be reviewed here. The clinical features and clues to a diagnosis of renovascular hypertension, as well as the treatment of renovascular hypertension and ischemic nephropathy, are presented elsewhere. (See "Evaluation of secondary hypertension", section on 'Clinical clues for renovascular hypertension' and "Treatment of unilateral atherosclerotic renal artery stenosis" and "Treatment of bilateral atherosclerotic renal artery stenosis or stenosis to a solitary functioning kidney" and "Treatment of fibromuscular dysplasia of the renal arteries" and "Clinical manifestations and diagnosis of chronic kidney disease resulting from atherosclerotic renal artery stenosis".)
INDICATIONS FOR TESTING
Testing for renovascular disease is warranted in patients who fulfill all of the following criteria :
●The clinical findings suggest a cause of secondary hypertension rather than primary hypertension (formerly called "essential" hypertension).
●The patient does not appear to have another cause of secondary hypertension such as primary kidney disease, primary aldosteronism, or pheochromocytoma. (See "Evaluation of secondary hypertension", section on 'Clues for other major forms of secondary hypertension'.)
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- INDICATIONS FOR TESTING
- DIAGNOSTIC TEST OPTIONS
- Testing options
- Duplex Doppler ultrasonography
- - Resistive index
- Spiral CT scan with CT angiography
- Magnetic resonance angiography
- Noninvasive imaging is less reliable in fibromuscular dysplasia
- Tests of limited utility, but occasionally performed
- - Plasma renin activity
- - Captopril renogram
- - Renal vein renin measurements
- SELECTING A DIAGNOSTIC TEST
- Patients without renal insufficiency
- Patients with renal insufficiency
- INTERPRETING THE RESULTS OF DIAGNOSTIC TESTS
- Incidental lesions
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS