Endocrine & metabolic · UKMLA & AKT
Renal artery stenosis
A free high-yield preview for the UKMLA Applied Knowledge Test, covering how to recognise this condition. The full SA Note notes add investigations, management and complications, with practice questions on this topic.
Key high-yield points
- Resistant hypertension - BP above target on 3+ antihypertensives at optimal doses (including a diuretic)
- Acute renal deterioration after ACEi/ARB - creatinine rise >20-30% within 2 weeks; classic clue for bilateral RAS
- Early-onset/severe hypertension in young women - think fibromuscular dysplasia (FMD)
- Flash pulmonary oedema - recurrent episodes without obvious cardiac cause, especially bilateral RAS
- Renal artery bruit - abdominal/flank; specific when present
- Unexplained renal asymmetry - one kidney >1.5 cm smaller than the other
- Hypokalaemia - secondary hyperaldosteronism from chronic RAAS activation
ACEi/ARB cause efferent arteriole dilatation - in bilateral RAS (or RAS in a solitary kidney), this collapses GFR. Stop the drug and investigate urgently if creatinine rises >20-30%.
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