The evaluati̇on of cli̇ni̇cal clues i̇n pati̇ents suspected of havi̇ng renovascular hypertensi̇on

ABSTRACT The Evaluation of Clinical Clues in Patients Suspected of having Renovascular Hypertension Renovascular hypertension (RVH) is a clinical situation characterized by high blood pressure in the presence of the renal artery(ies) stenosis (RAS). It is a very important disorder that could cause chronic renal failure and the most common yet correctable cause of secondary hypertension if diagnosed early. The gold standard for diagnosing RAS is renal angiography which is invasive and costly. There are numerous, commonly used rısk factors ındıcatıve of RAS. The aim of our prospective study is to find which clinical or laboratory signs are more determinant in the diagnosis of RVH. The end goal is to have only the patients presenting these determinant factors go through the invasive procedure of renal angiography. The study included 184 patients who were admitted due to hypertension and presented risk factor(s) for RVH. Of these patients, 77 were male (42%), 107 were female (58%) (mean age ± SD: 53.5 ± 14). All patients were performed three-dimensional time-of-flight Magnetic Resonance Angiography (MRA) with phase-contrast. Patients were divided into two groups as with or without stenosis. Statistical analysis was performed on the following study attributes: patient demographics, medical history, laboratory values, and risk factors for RAS. RVH was found in 32% of patients with hypertension. The following were found as significant risk factors for RVH; advenced age, low body mass index, high serum creatinine level, presence of proteinuria, in patients with diabetes mellitus, and chronic renal disease. Only the presence of renal asimetry and the history of coronary artery disease were found to be independent clinical predictors of RVH based on logistic regression anaylysis. In conclusion, detailed patient history and kidney size evaluation hold a great deal of importance for hypertension patients, as coronary artery disease and a difference in renal size more than 1.5 cm could be strong indications of RVH. Key words, Magnetic resonance angiography; renovascular hypertension; renal artery stenosis; systemic arterial hypertension;