What’s the best test for renal artery stenosis in patients with refractory hypertension?
Recommendations
The American College of Radiology recommends stratifying patients into 3 groups:
- high index of suspicion with normal renal function
- high index of suspicion with diminished renal function
- low index of suspicion.
Recommendations include:
,- MRA or CTA for high suspicion with normal renal function
- MRA or ultrasonography for high suspicion with impaired renal function
- All methods equally inappropriate if suspicion is low.3
Cost-effectiveness was not evaluated in the meta-analysis used to derive the guidelines.
The National Kidney Foundation recommends MRA and CTA as accurate, noninvasive, and consistent means of diagnosing RAS. The foundation also recommends duplex ultrasonography as a less invasive and less expensive alternative when local expertise is available. The guidelines include a moderately predictive rule for identifying patients who should be screened for renovascular hypertension—that is, patients with intermediate or high pretest probability (www.kidney.org/professionals/kdoqi/guidelines_bp/guide_4.htm).1
The American College of Cardiology and the American Heart Association list advantages and disadvantages of each diagnostic method and recommend choosing the one that is best suited to the patient.6
Acknowledgements
The opinions and assertions contained herein are the private view of the authors and are not to be construed as official, or as reflecting the view of the US Air Force Medical service or the US Air Force at large.
