renovascular cause of hypertension

 Q: 51 years old male is in ICU after severe hypertension (HTN) noted during his scheduled colonoscopy. All of the following are indicative of renovascular cause of hypertension EXCEPT? 

A) Severe hypertension resistant to treatment 

B) Acute rise in serum creatinine after start of ACE-I

C) Creatinine varies widely per patient's volume status 

D) Recurrent episodes of flash pulmonary edema 

E) Renal function improves after endovascular aortic stent graft.

Answer: E

Diagnosis of ischemic nephropathy requires a lot of clinical acumen ship. There are few indicative signs. It should be suspected where baseline investigations like urinalysis, proteinuria, or any use of nephrotoxic drugs fail to explain the deterioration of kidney function. In ICU, all of the choices from A to D are good indicators of renovascular disease. 

Kidney function tends to deteriorate after the placement of an endovascular aortic stent graft. This is not fully explained but various factors are suspected to play a role. It includes contrast nephropathy, ischemic-reperfusion injury, needs for ongoing surveillance computed tomography, and microembolization.

#nephrology

References:

1. Bahia SS, De Bruin JL. Long-Term Renal Function after Abdominal Aortic Aneurysm Repair. Clin J Am Soc Nephrol. 2015;10(11):1889-1891. doi:10.2215/CJN.09850915 

2. Rimmer JM, Gennari FJ. Atherosclerotic renovascular disease and progressive renal failure. Ann Intern Med 1993; 118:712.

3. Hadj-Abdelkader M, Alphonse JC, Ravel A, et al. [Proposal of a clinical prediction score for atheromatous renal artery stenosis]. Arch Mal Coeur Vaiss 2003; 96:784. 

4. Madder RD, Hickman L, Crimmins GM, et al. Validity of estimated glomerular filtration rates for assessment of baseline and serial renal function in patients with atherosclerotic renal artery stenosis: implications for clinical trials of renal revascularization. Circ Cardiovasc Interv 2011; 4:219.