Renovascular disease natural history, complications and prognosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

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Overview

Natural History

Complications

Prognosis

Favorable Predictors

Successful Outcome For Control Of Hypertension

  • Rapid acceleration of hypertension over the prior weeks or months
  • Presence of “malignant” hypertension
  • Hypertension in association with flash pulmonary edema
  • Contemporaneous rise in serum creatinine
  • Development of azotemia in response to ACE inhibitors administered for control of hypertension.

Successful Salvage Or Preservation Of Renal Function

  • Recent rapid rise in creatinine, unexplained by other factors
  • Azotemia resulting from ACE inhibitors
  • Absence of diabetes or other cause of intrinsic kidney disease
  • Presence of global renal ischemia, wherein the entire functioning renal mass is subtended by bilateral critically narrowed renal arteries or a vessel supplying a solitary kidney.

Unfavorable Predictors

  • Renal atrophy demonstrated by kidney length <7.5 cm on ultrasound
  • High renal resistance index detected by duplex ultrasound
  • Proteinuria > 1gm/day
  • Hyperuricemia
  • Creatinine clearance <40 mL/minute

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