Current RMA Instruments
| Reasonable Hypothesis SOP | 56 of 2020 |
| Balance of Probabilities SOP | 57 of 2020 |
Changes from previous Instruments
ICD Coding
- ICD-9-CM Codes: 440.1
- ICD-10-AM Codes: I70.1
Brief description
This SOP applies to atherosclerosis of a renal artery that either requires treatment or results in clinical manifestations in the form of: acute pulmonary oedema; chronic heart failure; persistent renal impairment; or hypertension that is either moderate to severe, or poorly controlled (i.e. difficult to control).
Confirming the diagnosis
Renal artery atherosclerotic disease needs to be distinguished from other causes of chronic kindney disease and other causes of secondary hypertension. The diagnosis requires imaging showing significant stenosis (typically > 60%) of a renal artery. CT angiography or MRI angiography are the preferred imaging methods. Duplex doppler ultrasound can also be used but is inconclusive if the test is negative. The condition is often unilateral.
The relevant medical specialist is a nephrologist.
Conditions not covered by SOP
- Renal artery stenosis due to fibromuscular dysplasia*
* another SOP applies
Clinical onset
The condition is likely to present with a deterioration in renal function (often rapid), or with onset or worsening of hypertension (particularly rapid development of severe hypertension). It may also cause acute pulmonary oedema (fluid in the lungs) or be found in connection with chronic heart failure. The condition can also be found incidentally from radiological imaging (with contrast) performed for another reason.
Clinical worsening
Effective treatment options are available in the form of medical (drug) therapy and control of risk factors, stenting, and surgery. The outcomes are variable, with improvement in some, stabilisation in others and progression to end stage renal disease in a further proportion.