A 63-year-old man with diffuse atherosclerosis and poorly controlled hypertension (BP 178/104 mmHg, HR 88/min) presents with a systolic abdominal bruit. Serum creatinine rises from 1.2 to 1.8 mg/dL within 2 weeks of starting lisinopril. Duplex ultrasound shows peak systolic velocity of 400 cm/s in the renal artery. He denies flank pain or hematuria. Which of the following is the most likely diagnosis?
- A)Autosomal dominant polycystic kidney disease
- B)Essential hypertension
- C)Primary hyperaldosteronism
- D)Pheochromocytoma
- E)Renal artery stenosisGABARITO
Explicação
Renal artery stenosis causes secondary hyperreninemic hypertension due to decreased renal perfusion. In a patient with bilateral disease or a solitary functioning kidney, ACE inhibition can reduce efferent arteriolar tone and precipitate a rise in creatinine. Ver explicação completa e trilha adaptativa →