Renal Artery Stenosis Clinical Prediction
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Age (yrs)
Gender Male Female
Atherosclerotic vascular disease Yes No
Recent onset of hypertension (<2 yrs) Yes No
Smoking history Ever Never
Body mass index >25 kg/M^2 <= 25 kg/ M^2
Presence of an abdominal bruit Yes No
Serum Creatinine concentration (mg/dL)
unit mg/dL µmol/L
Serum cholesterol >251 mg/dL (>6.5 mmol/L) OR use of cholesterol lowering agents Yes No
R e s u l t s
Probability of Renal Artery Stenosis (%)
? ? ?
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Renal Artery Stenosis Clinical Prediction

Renal Artery Stenosis (RAS) is a rare cause of hypertension, with renal angiography often being the definitive test to diagnose this condition. RAS results in decreased renal perfusion with the result being renovascular hypertension and renal insufficiency/failure.

This study included 477 hypertensive patients, from 26 hypertension clinics in the Netherlands. These 477 patients underwent angiography due to having one of these 2 items:

  • Drug resistant hypertension
  • Increase in serum creatinine during ACE-Inhibitor therapy

The goal of this study was to develop a clinical prediction rule to select patients who should undergo angiography more efficiently, in a manner to reduce the number of angiograms, without missing cases of RAS.

The following items were found to predict which patients had RAS:

  1. Age
  2. Gender
  3. Atherosclerotic vascular disease
  4. Recent onset of hypertension (<2 yrs)
  5. Smoking history (Present or past)
  6. Body mass index
  7. Presence of an abdominal bruit
  8. Serum Creatinine concentration
  9. Serum cholesterol

This model provided diagnostic accuracy similar to captopril renal scintigraphy (72% sensitivity, 90% specificity).

In patients with RAS on angiography, this model predicted risk of 49% +/- 29% and for patients with essential hypertension predicted risk of 15% +/-16%.

To calculate the Probability of Stenosis, the following formula is utilized:

P (stenosis) = RAS

LP = -7.033 + 0.052 × age + 0.029 × (75-age) × ever smoker - 0.877 × gender + 0.515 × atherosclerotic vascular disease + 0.565 × recent onset - 0.904 × obesity + 1.490 × abdominal bruit + 0.441 × hypercholesterolemia + 0.028 × serum creatinine

Reference:

Krijnen P, et. al. A clinical prediction rule for renal artery stenosis. Ann Intern Med. 1998 Nov 1;129(9):705-11.