Renovascular disease'

Flash pulmonary oedema, U&Es worse on ACE inhibitor, asymmetrical kidneys → renal artery stenosis - do duplex doppler ultrasound or MR angiography

Renal artery stenosis (RAS) is present in about 1% of patients with mild HTN, in up to 45% of Caucasian patients with severe hypertension, and in 25%-35% of patients with PAD;

Workup with Renal Duplex Doppler ultrasonography or CT or MRA

Ultrasound is preferable due to risk of contrast-induced nephropathy (with CT angiography) and nephrogenic systemic fibrosis (with gadolinium-enhanced MRA)

Consider non-contrast MRA if available

Diabetic nephropathy: stages

Diabetic nephropathy may be classified as occurring in five stages*:

Stage 1

• hyperfiltration: increase in GFR
• may be reversible

Stage 2 (silent or latent phase)

• most patients do not develop microalbuminuria for 10 years
• GFR remains elevated

Stage 3 (incipient nephropathy)

• microalbuminuria (albumin excretion of 30 - 300 mg/day, dipstick negative)

Stage 4 (overt nephropathy)

• persistent proteinuria (albumin excretion > 300 mg/day, dipstick positive)