brooklynmed
Forum Newbie
Topics: 10
Posts: 19
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Ok....I've read a bunch of previous posts and am still confused about this. Is captopril renogram better than renal ultrasound?? Which one do you do FIRST? When would you do it? only when someone is resistant to conventional anti-hypertensives? If a pat. comes to you and is hypertensive do you first check lipid levels, or try life style modification (i.e. weight loss)?? Anyone can help, I'd appreciate the clarification.
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| me007
Forum Guru
Topics: 72
Posts: 803
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you suspect secondary HTN if
1. pt<25 yo or >55
2. sudden oncet or sudden worsening of HTN
3. pt does not respond to standard meds
in 50% RAS pts you can hear bruit - upper abd, radiates laterally
The captopril renogram is the best noninvasive test confirming RAS (use if renal function is normal)
ultasound might be the first because of cost
The arteriogram - gold standard but do not use in pts with RF
MRI - high specificity/sensitivity and can be used in pts with RF
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| drduck
Forum Guru
Topics: 82
Posts: 529
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i really have no idea about captopril renogram,
but if patient with hypertension comes for the first visit....he shud undergo investigation....to exclude secondary causes.
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| drduck
Forum Guru
Topics: 82
Posts: 529
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investigations also helpful to know and calculate the average risk the patient have.
i mean the major risk factors....which wud surely have some impact on the therapy and prognosis...
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| chemamr
Moderator and PGY2
Topics: 703
Posts: 4,442
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renal artery stenosis:
screening tests: MRA, spiral CT scan, duplex doppler U/S. if inconclusive and you still think it IS, then you can go for the gold standard: renal arteriography.
when do you do it or suspect secondary HTN? agree with me077's answer.
If a pat. comes to you and is hypertensive do you first check lipid levels, or try life style modification (i.e. weight loss)?? yes, newly Dx HTN, you check FLP, BMP to look for more cardiovascular risk factors and simultaneously you are checking for possible abnormalities that could guide you for secondary causes of HTN.
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