Q: I am a 32 years old unmarried woman having kidney problems for the last one year. Initially my blood pressure (BP) was 220 mm Hg with creatinine at 3.6 mg/dl. I did an ultrasound, which was clear but captopril renogram showed impaired renal function. With medication and diet my BP has come down to 130/80 mm Hg. I was taking Amlodipine 10 mg, Atenolol 50 mg twice daily and Telmisartan 80 mg. But, due to swelling in the legs my medicines have been changed to Atenolol 50 mg twice daily, Telsar H 40 mg, Telsar 40 mg and Amlodipine 5 mg. I am also taking Livogen and Lacarnit. My present creatinine level is 2.3 mg/dl, with electrolytes within limits; sodium levels are more towards the lower limit. The doctor diagnosed it as chronic kidney disease (CKD). Should he investigate the type of hypertension I have? Also, I came to know about bilateral RAS. Should I be tested for that? If so, what kind of test is it? Should I ask the doctor to do the same?

A:Review of your history is suggestive of you having chronic kidney disease, which is always accompanied with hypertension as one of the complication of impaired kidney function. In someone with significant loss of kidney function as in your case, elevated blood pressure results from increased retention of salt and water which other wise would have been filtered out by normal kidneys. Currently it seems that you have been able to achieve the BP goal of 130/80 mm Hg with appropriate combination of medications. Rarely, a significant blockage of renal arteries (renal artery stenosis) can be an additional cause of difficult to control BP, which doesn’t seem to be the case in you at this point. However, one can certainly rule it out by imaging tests including Doppler ultrasonogram study of arteries and more effectively by angiographic studies of arteries if there is a strong clinical suspicion. This decision would need to be taken by your nephrologist based on your blood pressure control.