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Renal Artery Doppler Ultrasound for Renovascular Hypertension

Noninvasive duplex ultrasound to detect renal artery stenosis as a treatable cause of secondary hypertension.

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

References (5)

This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Radyoloji department. Book Appointment →

What is Renal Artery Doppler Ultrasound for Renovascular Hypertension?

Renal artery Doppler combines B-mode imaging with color and spectral Doppler to evaluate flow velocities in the main renal arteries, segmental branches and aortic flow. Peak systolic velocity (PSV) >180-200 cm/s, renal-aortic ratio (RAR) >3.5 and turbulent flow suggest >60% stenosis.

It detects atherosclerotic ostial disease in older adults, fibromuscular dysplasia in younger women (string-of-beads pattern with mid-distal stenosis), renal artery aneurysm and dissection. Resistive index (RI) >0.80 in interlobar arteries indicates poor revascularization candidacy.

Guidelines (KDIGO, ESH/ESC, AHA) recommend Doppler as initial screening when clinical suspicion is high: resistant hypertension on >=3 drugs, abdominal bruit, unilateral small kidney, flash pulmonary edema or rapid renal function decline after ACE inhibitor.

Symptoms

Resistant hypertension despite >=3 antihypertensives
Abrupt-onset hypertension <30 or >55 years
Abdominal or flank bruit on auscultation
Unilateral small kidney on prior imaging
Flash pulmonary edema episodes
Worsening renal function after ACE inhibitor
Unexplained hypokalemia with hypertension
Severe atherosclerosis with hypertension

Risk Factors

Atherosclerosis (smoking, diabetes, dyslipidemia)
Fibromuscular dysplasia in young women
Family history of fibromuscular dysplasia
Renal trauma or prior renal artery dissection
Vasculitis (Takayasu, polyarteritis nodosa)
Aortic aneurysm with renal artery involvement
Solitary kidney with hypertension
Chronic kidney disease worsening on ACE inhibitor

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • Resistant hypertension on multiple agents
  • Sudden-onset severe hypertension
  • Renal function decline after starting ACE inhibitor
  • Abdominal bruit on examination
  • Flash pulmonary edema with hypertension
  • Young woman with secondary hypertension

Treatment Methods

01
Patient preparation with overnight fasting
02
B-mode evaluation of kidney size and parenchyma
03
Color and spectral Doppler of main renal arteries
04
Peak systolic velocity and renal-aortic ratio measurement
05
Resistive index calculation in interlobar arteries
06
Confirmation with CT or MR angiography if abnormal
07
Multidisciplinary review with nephrology and cardiology
08
Periodic surveillance after revascularization

Which Department to Visit?

You can visit our Radyoloji department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.