How do you usually diagnose renal artery stenosis?

Renal arter stenosis: The diagnosis is made with ultrasound dopplers to check blood flow rates that reveal waves created by the blockage, or arteriograms.Ultrasound has no risk, but is very operator dependent and can be misleading in both over and under diagnosis.Arteriograms are more accurate, but only show an anatomic blockage, and don't help with functional testing. Finding blocks doesn't mean they need treatment.

MRA or CTangio: We suspect ras when creatinine gets worst after using ace inhibitors . Triple phase nuclear scans and nuclear renal study with Captopril stimulation may help as screening tests. Doppler ultrasound is difficult and unreliable at present. Only after stents are placed in the stenosis renal arteries if the renal numbers get better we are assured the diagnosis was correct. Mra or ct angio are riskier.

DX RAS: 33F asks do you Dx renal artery stenosis. 1. I take a detailed history of the HTN searching for sudden onset and difficult to control and severe HTN> 2. I listen for a renal artery bruit in the belly over the kidney area (caused by blood gushing thru a narrowed artery. At you age I hear this in about 75% who have RAS. 3. Do selective renal arteriogram. 4.Measure renin from each renal vein.