Hypertension (Suspected Renovascular Cause)

Population Covered By The Guidance

This pathway provides guidance on the imaging of adult patients with suspected renovascular hypertension

Lead Researcher: Balaji Kodivalasa

Experts & Contributors: Drawn from Clinical Advisors
Link to Clinical Advisors

Editorial Panel: Core membership
Link to Editorial Panel

Date reviewed: January 2012

Date Published: January 2012

Image 1 (Magnetic Resonance Angiography): Coronal image demonstrating bilateral renal artery stenosis.

Bilateral Renal Artery Stenosis

Image 2a, 2b and 2c (Digital Subtraction Angiography): Pre- and post-stent images of bilateral renal artery stenosis.

Bilateral Renal Artery Stenosis

Image 2a, 2b and 2c (Digital Subtraction Angiography): Pre- and post-stent images of bilateral renal artery stenosis.

Bilateral Renal Artery Stenosis

Image 2a, 2b and 2c (Digital Subtraction Angiography): Pre- and post-stent images of bilateral renal artery stenosis.

Bilateral Renal Artery Stenosis

 

References are graded from Level I to V according to the Oxford Centre for Evidence-Based Medicine, Levels of Evidence. Download the document

  1. Krumme B, Blum U, Schwertfeger E, et al. Diagnosis of renovascular disease by intra- and extrarenal Doppler scanning. Kidney Int. 1996;50:1288-92. (Level II/III evidence)
  2. Radermacher J, Brunkhorst R. Diagnosis and treatment of renovascular stenosis - a cost-benefit analysis. Nephro Dial Transplant. 1998;13:2761-7. (Level III evidence)
  3. Boudewijn G, Vasbinder GBC, Neelmans PJ, Kessels AGH, et al. Diagnostic tests for renal artery stenosis in patients suspected of having renovascular hypertension: a meta-analysis. Ann Intern Med. 2001;135:401-11. (Level I/II evidence). View the reference
  4. Radermacher J, Chavan A, Bleck J, et al. Use of Doppler ultrasonography to predict the outcome of therapy for renal-artery stenosis. N Engl J Med. 2001;344:410-7. (Level I/II evidence). View the reference
  5. Krijnen P, Van Jaarsveld BC, Steyerberg EW, et al. A clinical prediction rule for renal artery stenosis. Ann Intern Med. 1998;129:705-11. (Level II evidence). View the reference
  6. Pedersen EB. New tools in diagnosing renal artery stenosis. Kidney Int. 2000;57:2657-77. (Review article)
  7. Rankin SC, Saunders AJS, Cook GJR, et al. Renovascular disease. Clin Radiol. 2000;55:1-12. (Review article)
  8. Qanadli SD, Soulez G, Therasse E, et al. Detection of renal artery stenosis: prospective comparison of captopril-enhanced Doppler sonography, captopril-enhanced scintigraphy, and MR Angiography. AJR Am J Roentgenol. 2001;177:1123-9. (Level III evidence)
  9. Van Jaarsveld BC, Krijnen P, Pieterman H, et al. The effect of balloon angioplasty on hypertension in atherosclerotic renal artery stenosis. N Engl J Med. 2000;342:1007-14. (Level II evidence). View the reference
  10. Leertouwer TC, Gussenhoven EJ, Bosch JL, et al. Stent placement for renal arterial stenosis: where do we stand? A meta-analysis. Radiology. 2000;216:78-85. (Level II evidence). View the reference
  11. Weibull H, Bergqvist D, Bergentz S-E, et al. Percutaneous transluminal renal angioplasty versus surgical reconstruction of atherosclerotic renal artery stenosis: a prospective randomized study. J Vas Surg. 1993;18:841-52. (Level II evidence). View the reference
  12. Baumgartner I, von Aesch K, Do D-D, et al. Stent placement in ostial and nonostial atherosclerotic renal arterial stenoses: a prospective follow-up study. Radiology. 2000;216:498-505. (Level II evidence). View the reference
  13. van de Ven PJ, Kaatee R, Beutler JJ, et al. Arterial stenting and balloon angioplasty in ostial atherosclerotic renovascular disease: a randomised trial. Lancet. 1999;353:282-86. (Level II evidence). View the reference
  14. Parker SC, Hannah A, Brooks M, et al. Renal artery stenosis: a disease worth pursuing. Med J Aust. 2001;175:149-53. (Clinical update)
  15. Harward TR, Poindexter B, Huber TS, Carlton LM, Flynn TC, Seeger JM. Selection of patients for renal artery repair using captopril testing. Am J Surg. 1995;170:183-7. (Level III evidence)
  16. Ramsay LE, Waller PC. Blood pressure response to percutaneous transluminal angioplasty for renovascular hypertension: an overview of published series. Br Med J. 1990;300:569-72. (Level III evidence)
  17. Ramos F, Kotliar C, Alvarez D, et al. Renal function and outcome of PRTA and stenting for atherosclerotic renal artery stenosis. Kidney Int. 2003;63:276-82. (Level II/III evidence)
  18. Zeller T, Frank U, Muller C, et al. Predictors of improved renal function after percutaneous stent-supported angioplasty of severe atherosclerotic ostial renal artery stenosis. Circulation. 2003;108:2244-9. (Level II evidence). View the reference
  19. Watson PS, Hadjipetrou P, Cox SV, Piemonte TC, Eisenhauer AC. Effect of renal artery stenting on renal function and size in patients with atherosclerotic renovascular disease. Circulation. 2002;102:1671-77. (Level II evidence). View the reference
  20. Dworkin L, Cooper C. Renal-artery stenosis. N Engl J Med. 2009;361:1972-8. (Review article)
  21. Grobner T. Gadolinium - a specific trigger for the development of nephrogenic fibrosing dermopathy and nephrogenic systemic fibrosis? Nephrol Dial Transplant. 2006;21:1104-8. (Level II evidence). View the reference
  22. Wheatley K, Ives N, Gray R, Kalra P, Moss J, Baigent C, et al. Revascularization versus medical therapy for renal-artery stenosis. N Engl J Med. 2009;361:1953-62. (Level I evidence)
  23. High WA, Ayers RS, Chandler J et al. Gadolinium is dectectable within the tissue of patients with nephrogenic systemic fibrosis. J Am Acad Dermatol. 2007;56:21-6. (Level III evidence)
  24. Boyd AS, Zic JA, Abraham JL. Gadolinium deposition in nephrogenic fibrosing dermopathy. J Am Acad Dermatol. 2007;56:27-30. (Review article)
  25. MRI Reference Group, Standards of Practice & Accreditation Commitee. RANZCR NSF Guidelines. October 2009. (Guideline document)
  26. Centers for Disease Control and Prevention (CDC). Nephrogenic fibrosing dermopathy associated with exposure to gadolinium-containing contrast agents--St. Louis, Missouri, 2002-2006. MMWR Morb Mortal Wkly Rep. 2007;56(7):137-41. (Level III evidence). View the reference
  27. Lim YL, Lee HY, Low SC, Chan LP, Goh NS, Pang SM. Possible role of gadolinium in nephrogenic systemic fibrosis: report of two cases and review of the literature. Clin Exp Dermatol. 2007;32(4):353-8. (Level IV evidence). View the reference

Pathway User Guide

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Zoom & Pan Controls: Use + / − or the slider to zoom. Reset returns to default. Tick Panning to drag the diagram when zoomed.

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The relative radiation level (RRL) of each imaging investigation is displayed in the pop up box.

SYMBOL RRL EFFECTIVE DOSE RANGE
No radiation None 0
Minimal radiation Minimal < 1 millisieverts
Low radiation Low 1-5 mSv
Medium radiation Medium 5-10 mSv
High radiation High >10 mSv

Disclaimer

Status Of Recommendations Each pathway is designed to assist clinicians in situations when faced with a large array of possible diagnostic tests and examinations. However, it is recognised that diagnostic practice may differ from a particular pathway depending on local availability of equipment and expertise, as well as the experience of individual clinicians. Therefore each pathway is neither a rigid set of rules, nor a substitute for clinical assessment, and individual patient circumstances should always be considered.

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