Renal artery stenosis
Long-term hypertension, which had been medically controlled until a recent sharp increase in blood pressure.
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- Aorta at the level of the SMA.
- The lumen of the origin, proximal and mid RRA appears narrowed with some aliasing under color Doppler ultrasound.
- The lumen of the distal RRA appears normal and no aliasing is seen.
- Velocity at the RRA origin is markedly increased. There is a 5-fold increase over the velocity within the aorta. These findings suggest a >70% stenosis.
- Velocities within the proximal RRA remain markedly elevated.
- Velocities within the mid RRA remain markedly elevated.
- Velocity in the distal RRA is within normal limits. No tardus-parvus waveforms were seen.
- The intrarenal waveforms in the right kidney are OK - possible loss of the early systolic peak. The resistive indices were >0.5 lower than in the left kidney (see next picture) supporting compromised blood supply to the right kidney.
- There is an early systolic peak in the intrarenal waveforms of the left kidney. Resistive indices were >0.5 higher than in the right kidney.
Markedly elevated velocities, a renal-aorta-ratio up to 5 and apparent luminal narrowing and aliasing from the origin to mid-point of the right renal artery. Greater than 0.5 difference in the resistive indices of the intrarenal waveforms between both kidneys. These findings suggest a >70% stenosis in the right renal artery despite tardus-parvus waveforms not being seen.
There is a 5-fold increase of renal artery velocity over aortic velocity. These findings suggest a >70% stenosis.