What are the class I recommendations for establishing a diagnosis of renal artery stenosis (RAS)?

Updated: Nov 02, 2020
  • Author: Bruce S Spinowitz, MD, FACP; Chief Editor: Vecihi Batuman, MD, FASN  more...
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Answer

Class I recommendations for establishing a diagnosis of RAS generally concur and include the following [56, 57] :

  • Duplex ultrasonography (DUS) is the first-line test
  • Computed tomography angiography in patients with creatinine clearance >60 mL/min
  • Magnetic resonance angiography in patients with creatinine clearance >30 mL/min

When the clinical index of suspicion is high and the results of noninvasive tests are inconclusive, ACC/AHA recommends catheter angiography, [56] while ESC recommends digital subtraction angiography. [57]

Both guidelines are in agreement that captopril renal scintigraphy, selective renal vein renin measurements, plasma renin activity, and the captopril test are not recommended as useful screening tests for RAS (class III). [56, 57]


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