Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with uncontrolled hypertension despite multi-drug regimen, suggestive of renovascular etiology. History significant for atherosclerotic risk factors (smoking, dyslipidemia, DM). Reports of recent decline in GFR, particularly following initiation of ACE inhibitor or ARB therapy. No history of flash pulmonary edema or refractory heart failure.
Clinical Examination Findings
General appearance: Well-nourished, no acute distress. Vital signs: BP elevated in both upper extremities. Skin: Evidence of generalized atherosclerosis (e.g., xanthomas, diminished peripheral pulses). Abdomen: Auscultation reveals a systolic-diastolic abdominal bruit, localized to the epigastrium or periumbilical region, highly specific for renal artery stenosis.
Treatment Protocol
Initiate medical management: Dual/triple antihypertensive therapy including CCB and diuretics. ACE inhibitors/ARBs are contraindicated if bilateral stenosis or solitary kidney is present. Consider statin therapy and antiplatelet agents (aspirin) for atherosclerotic stabilization. Evaluate for revascularization (renal artery stenting) if patient meets criteria for hemodynamically significant stenosis or refractory hypertension.