She has no known drug allergies. Also, a patient whose hypertension is becoming increasingly more difficult to control with medications suggests renovascular disease, implying that the renal artery stenosis is becoming more severe. This fall is sensed by the juxtaglomerular apparatus, which responds by increasing production of renin. Also, through increased production of aldosterone, the kidneys hold on to more sodium and water, and a hypervolemia develops. On physical examination, the patient is in no apparent distress.
Lungs are clear, the heart has a regular rate and rhythm.
The abdomen is soft without masses. There is a faint bruit audible in the left flank. A very good, reliable, noninvasive method to image the renal arteries and determine the presence of renal artery stenosis. The gold standard for imaging the renal arteries. However, this test is invasive and expensive, so it is not ideal for screening purposes.