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A 25-year-old white woman comes to your office today to meet you for the first time. Her only complaint is of headaches. Her blood pressure is 160/105 mm Hg in both arms. She is obese and otherwise has a normal physical examination with no bruits in her abdomen. Two weeks and three weeks later, her blood pressure remains elevated at 155/107 and 157/105 mm Hg, respectively. She smokes but does not drink alcohol. Laboratory studies show:

Sodium 138 mEq/L, potassium 4.7 mEq/dL, BUN 14 mg/dL, creatinine 0.8 mg/dL. Urinalysis reveals +1 protein, with no red or white cells.

What is the next step to confirm a diagnosis?

(A) Doppler (duplex) ultrasound of the kidneys
(B) Start lisinopril
© Magnetic resonance imaging (MRI) of the abdomen
(D) Captopril renography
(E) Angiography

Option A?

D...

dddd

(D) Captopril renography

start lisnopril.

what does she have>?

she has to be ruled out for a renal artery stenosis

She is obese and otherwise has a normal physical examination with no bruits in her abdomen. is it not point to exclude Renal artery stenosis? no bruits?

it is known that u might not hear bruit in obese patient....its already difficult to hear in normal patient