Make the Diagnosis: Abdominal Bruits
Patients without hypertension should not have auscultation for asymptomatic renal artery bruits because bruits frequently are a normal finding. The search for renal artery stenosis should be confined to certain patient populations (see below). When present in these populations, an abdominal bruit is the most useful physical examination finding for assessment of renal artery stenosis.
Prior Probability of Renovascular Disease
Approximately 1% to 5% of the general population has renovascular disease. Approximately 20% of white patients with medically refractory hypertension have renal artery stenosis.
Population for Whom Renal Artery Stenosis Should Be Considered
Onset of hypertension before 30 years of age
Patients with an arterial bruit and hypertension, especially if there is a diastolic component
Hypertension that becomes resistant to medication
Flash pulmonary edema
Renal failure, especially in the absence of proteinuria or an abnormal urine sediment result
Acute renal failure precipitated by angiotensin-converting enzyme inhibitors or angiotensin-receptor blockers
Detecting the Likelihood of Renal Artery Stenosis in Patients With Refractory Hypertension
Table 3-5Clinical Examination Findings for Renal Artery Stenosis ||Download (.pdf) Table 3-5 Clinical Examination Findings for Renal Artery Stenosis
|Finding (No. of Studies) ||LR+ (95% CI) ||LR– (95% CI) |
|Systolic-diastolic bruit (n = 1) ||39 (10-145) ||0.62 (0.49-0.73) |
|Systolic bruit (n = 3) ||4.3 (2.3-8.0) ||0.52 (0.34-0.78) |
|History of atherosclerotic disease (n = 1) ||2.2 (1.8-2.8) ||0.52 (0.40-0.66) |
Moderate-risk and high-risk patients are subjected to a noninvasive screening test (ultrasonography, computed tomography, magnetic resonance imaging). The type of imaging modality for screening (eg, contrast-enhanced ultrasonography vs gadolinium-enhanced computed tomography or magnetic resonance angiography) may be operator dependent, and physicians will need to rely on their local radiologists’ expertise. All patients have their disease status confirmed with arteriography as part of a therapeutic procedure.
Original Article: Is Listening for Abdominal Bruits Useful in the Evaluation of Hypertension?
Abdominal Bruits: Introduction
Toward the end of an unusually busy clinic, a clinical clerk greets the final patient of the day, a man with a recently documented increase of blood pressure. With all the enthusiasm that remains after 4 years of medical training, she compulsively listens for abdominal bruits. Almost surprised, she hears a soft systolic-diastolic epigastric bruit and is faced with the inevitable question: so what?
Why Is This an Important Question to Answer With a Clinical Examination?
As we have gained insight into the origin and meaning of vascular bruits, detailed auscultation of the abdomen has become more common. Once detected, an abdominal ...