📋 HISTORY
🔹 55-year-old female
🔹 Resistant hypertension
🔹 CT abdomen findings:
• Small right kidney with delayed contrast enhancement
• Enlarged left kidney with normal contrast enhancement
――――――――――――――
🔬 INVESTIGATION
CT Abdomen:
• Right kidney → Small + delayed contrast enhancement
• Left kidney → Enlarged + normal contrast enhancement
🔹 Implies unilateral renal ischemia with compensatory contralateral hypertrophy
――――――――――――――
❓ QUESTION
Which physical examination finding is MOST LIKELY to be present?
🔹 55-year-old female
🔹 Resistant hypertension
🔹 CT abdomen findings:
• Small right kidney with delayed contrast enhancement
• Enlarged left kidney with normal contrast enhancement
――――――――――――――
🔬 INVESTIGATION
CT Abdomen:
• Right kidney → Small + delayed contrast enhancement
• Left kidney → Enlarged + normal contrast enhancement
🔹 Implies unilateral renal ischemia with compensatory contralateral hypertrophy
――――――――――――――
❓ QUESTION
Which physical examination finding is MOST LIKELY to be present?
🅐 Splenic bruit
🅑 Renal bruit
🅒 Hepatic bruit
🅓 Iliac bruit
❌ WHY OTHERS ARE WRONG
🅐 Splenic bruit
Heard in splenic artery pathology, not associated with renal artery stenosis or hypertension in this context.
🅒 Hepatic bruit
Suggests hepatic artery pathology or hepatocellular carcinoma, unrelated to renal asymmetry findings here.
🅓 Iliac bruit
Indicates peripheral arterial disease of the iliac vessels, not relevant to the renal findings described.
🅐 Splenic bruit
Heard in splenic artery pathology, not associated with renal artery stenosis or hypertension in this context.
🅒 Hepatic bruit
Suggests hepatic artery pathology or hepatocellular carcinoma, unrelated to renal asymmetry findings here.
🅓 Iliac bruit
Indicates peripheral arterial disease of the iliac vessels, not relevant to the renal findings described.
❓ FAQ: Renal Artery Stenosis
1. What is renal artery stenosis?
Narrowing of one or both renal arteries, leading to reduced blood flow to the kidney(s).
2. What are the two main causes?
Atherosclerosis (common in older patients) and fibromuscular dysplasia (common in young women).
3. What is the classic clinical clue?
Resistant hypertension, especially with a renal bruit on auscultation.
4. Why does stenosis cause hypertension?
Reduced renal perfusion activates the renin-angiotensin-aldosterone system, raising blood pressure.
5. What CT finding is characteristic?
A small kidney with delayed contrast enhancement on the affected side.
6. Why does the contralateral kidney enlarge?
It undergoes compensatory hypertrophy due to increased workload from reduced flow on the other side.
7. What is the best initial screening test?
Doppler ultrasound of the renal arteries.
8. What is the gold standard investigation?
Renal angiography (CT, MR, or catheter-based).
9. Which antihypertensives should be used cautiously?
ACE inhibitors and ARBs, as they can precipitate acute kidney injury in bilateral stenosis.
10. What are the treatment options?
Medical management of hypertension, angioplasty with stenting, or surgical revascularization in select cases.
https://www.effectivecpmnetwork.com/p6x5cixrpy?key=0e3ba72754512fdd23ee8b77a5e394ed
1. What is renal artery stenosis?
Narrowing of one or both renal arteries, leading to reduced blood flow to the kidney(s).
2. What are the two main causes?
Atherosclerosis (common in older patients) and fibromuscular dysplasia (common in young women).
3. What is the classic clinical clue?
Resistant hypertension, especially with a renal bruit on auscultation.
4. Why does stenosis cause hypertension?
Reduced renal perfusion activates the renin-angiotensin-aldosterone system, raising blood pressure.
5. What CT finding is characteristic?
A small kidney with delayed contrast enhancement on the affected side.
6. Why does the contralateral kidney enlarge?
It undergoes compensatory hypertrophy due to increased workload from reduced flow on the other side.
7. What is the best initial screening test?
Doppler ultrasound of the renal arteries.
8. What is the gold standard investigation?
Renal angiography (CT, MR, or catheter-based).
9. Which antihypertensives should be used cautiously?
ACE inhibitors and ARBs, as they can precipitate acute kidney injury in bilateral stenosis.
10. What are the treatment options?
Medical management of hypertension, angioplasty with stenting, or surgical revascularization in select cases.
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