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Do I need to go for renal artery blockage investigation?

Q: I am a 35 years old male with stones in my gall bladder. I am going for surgery next week. During my ultrasound, I was diagnosed with a small kidney and on further investigation; it was found that my right kidney is practically non-functional with a size 70x30 mm. My DTPA scan shows enlarged left kidney in normal shape and placement, well perfused and the cortical tracer uptake is good with normal parenchymal transit time with good drainage. The left kidney is 92.4 % functional and the right one is just 7.6 % functional. My Kidney function test and urine tests are normal. I had no pain or symptoms related to right kidney and no infections but I have been suffering with hypertension for the last 3-4 years and had occasional high BP in spite of medication (Telma H). I had also not been very regular in taking my BP medicine. Further, I also had undergone a surgery to treat liver abscess eight years back and during this had few ultrasounds done but none of them had pointed out small kidney at that time. My nephrologist has now told me that I was born with a small kidney, which may not have been detected/missed out in my past investigation, and that I should now follow medication to control my BP and lead normal life. He has also advised me a changed dose for controlling hypertension to Telma 40 mg in the morning and Amlodipine 2.5 mg in the evening and as of now my blood pressure is within control and around 115/75 mmHg (average). The nephrologist has asked me to go for renal artery blockage investigation. I feel that this shrinking of my Kidney has happened in last 4 years and is due to a renal artery blockage. To add, my mother has recently been detected with just one left kidney by birth so I am not sure if this problem is hereditary. Please advise should I go for further investigation or leave it as it is and control my BP?

A:You should continue to focus on your blood pressure (target BP goal <130/80 mmHg) as advised by your Nephrologist. You have a well functioning left kidney and as long as your overall kidney function is stable(would also be obvious by checking serum creatinine level) and blood pressure is well controlled, there is no reason to pursue additional tests even to rule out renal artery blockage (which would seem unlikely in the above scenario). Additionally, one could check urine to quantify albumin/protein leakage which often is present in some one with hypertension.

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