6 doctors weighed in:

How do you usually diagnose renal artery stenosis?

6 doctors weighed in
Dr. Anthony Cusano
Internal Medicine - Nephrology & Dialysis
3 doctors agree

In brief: 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.

In brief: 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.
Dr. Anthony Cusano
Dr. Anthony Cusano
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1 comment
Dr. Clarence Grim
In my 50 year experience one must do a selective renal arteriogram to DX RAS. This is the only good way to pick up the blockage in a branch of a renal artery. The only way to tell if the blockage is causing the HTN is to do what is called renal vein renin study. Never let anyone mess with your renal artery without such a study of renal vein renin.
Dr. Pedro Hernandez
Internal Medicine - Geriatrics
2 doctors agree

In brief: 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.

In brief: 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.
Dr. Pedro Hernandez
Dr. Pedro Hernandez
Thank
2 comments
Dr. Clarence Grim
Based on 50 years of experience if you want to know if renal artery stenosis is causing the HTN you MUST do a selective renal arteriogram by a skilled renal angiographer. Need mess with a renal artery unless you know it is the cause o the BP. The only reliable indicator of this is to measure renin coming from each kidney in what is called a renal vein renin test.
Dr. Clarence Grim
That should be never mess with a renal artery unless if is causing the kidney to produce excess renin.
Dr. Clarence Grim
Internal Medicine - Endocrinology
1 doctor agrees

In brief: 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.

In brief: 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.
Dr. Clarence Grim
Dr. Clarence Grim
Thank
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