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2009 ; 361
(20
): 1972-8
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Clinical practice Renal-artery stenosis
#MMPMID19907044
Dworkin LD
; Cooper CJ
N Engl J Med
2009[Nov]; 361
(20
): 1972-8
PMID19907044
show ga
A 73-year-old former smoker with a history of hypertension and dyslipidemia
presents to the emergency department with shortness of breath. His blood pressure
is 160/75 mm Hg, heart rate 60 beats per minute, and respiratory rate 24 breaths
per minute. Chest auscultation reveals diffuse rales, and there is 1+ pitting
edema. The serum creatinine level is 1.4 mg per deciliter (124 µmol per liter)
(estimated glomerular filtration rate, 52 ml per minute), and urinalysis shows 1+
protein. His condition improves after treatment with intravenous diuretics, but
his systolic blood pressure remains elevated, at 170 mm Hg. Magnetic resonance
angiography (MRA) reveals a diseased aorta, a high-grade ostial lesion of the
left renal artery that is consistent with atherosclerotic stenosis, and a normal
right renal artery. How should he be further evaluated and treated?
|Aged
[MESH]
|Angioplasty, Balloon
[MESH]
|Angiotensin-Converting Enzyme Inhibitors/therapeutic use
[MESH]
free
free
free
