Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with uncontrolled hypertension despite multi-agent antihypertensive therapy. Reports associated symptoms of episodic flank pain, nocturia, or worsening renal function following initiation of ACE inhibitor or ARB therapy. No history of acute trauma or recent systemic embolic events.
Clinical Examination Findings
Cardiovascular exam reveals a localized abdominal bruit, typically heard in the epigastrium or flank. Peripheral pulses are symmetric, though diminished femoral pulses may be noted in cases of associated aortoiliac disease. Blood pressure measurements are consistently elevated in both upper extremities.
Treatment Protocol
Management plan includes optimization of blood pressure control using calcium channel blockers or diuretics. Initiation of statin therapy and antiplatelet agents for atherosclerotic risk reduction. Referral for renal artery duplex ultrasound or CT angiography to assess stenosis severity. Consideration for percutaneous transluminal renal angioplasty (PTRA) with or without stenting if hemodynamically significant stenosis is confirmed.