Endocrine & metabolic · UKMLA & AKT
Renal artery stenosis
A free high-yield preview for the UKMLA Applied Knowledge Test. Below are the key points to recognise renal artery stenosis — the full SA Note notes add investigations, management, complications and 10 practice questions.
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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