Rosner listed clinical factors that can help identify patients at increased risk for renal arterial stenosis and renovascular hypertension. Use of diagnostic studies are justified in these patients. The author is from the University of Virginia in Charlottesville.
Parameters:
(1) abdominal or flank bruit
(2) high grade retinopathy
(3) signs or symptoms of peripheral vascular disease
(4) hypertension refractory to 3 or more drugs
(5) elevated serum creatinine after ACE inhibitors (excluding volume depletion, hypotension or diuretic effect)
(6) serum creatinine
(7) age
(8) incidental finding of asymmetry in kidney size
|
Parameter |
Finding |
Points |
|
age of the patient |
> 60 years |
1 |
|
|
<= 60 years |
0 |
|
abdominal or flank bruit |
present |
1 |
|
|
absent |
0 |
|
high grade retinopathy |
present |
1 |
|
|
absent |
0 |
|
peripheral vascular disease |
present |
1 |
|
|
absent |
0 |
|
hypertension |
refractory to 3 or more drugs |
1 |
|
|
refractory to 1-2 drugs |
0 |
|
|
nonrefractory to drugs |
0 |
|
serum creatinine after ACE inhibitor |
elevated not because of volume depletion, hypotension or diuretic effect |
1 |
|
|
elevated because of volume depletion, hypotension or diuretic effect |
0 |
|
|
normal |
0 |
|
serum creatinine |
> 1.4 mg/dL |
1 |
|
|
<= 1.4 mg/dL |
0 |
|
size of the 2 kidneys |
asymmetry in size |
1 |
|
|
comparable in size |
0 |
number of risk factors present =
= SUM(number of points for risk factors)
Interpretation:
• minimum number of risk factors: 0
• maximum number of risk factors: 8
• The higher the number of risk factors, the greater the chance of renal arterial stenosis.
|
Number of Risk Factors |
Risk of Renovascular Hypertension |
|
0 |
low |
|
1 or 2 |
moderate (10-20%) |
|
>= 3 |
high (> 20%) |
Purpose: To identify a hypertensive patient at risk for renal arterial stenosis using the risk factors of Rosner.
Specialty: Nephrology, Clinical Laboratory
Objective: risk factors, selection
ICD-10: I70.1, I15.1,
