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When Is Screening for Renal Artery Stenosis Medically Necessary?
Date:11/24/2008

PORTLAND, Ore., Nov. 24 /PRNewswire/ -- After diabetes and hypertension, renal artery stenosis is the leading cause of kidney failure. Recent changes in the opinions of nephrologists and cardiologists, as well as new medical guidelines, are increasing doctors' awareness of the need to screen for it.

"Our aging population, especially older patients with cerebrovascular, cardiac, and peripheral arterial disease increases the frequency of renal artery stenosis," said Dr. Skip Freedman, Executive Medical Director at AllMed Healthcare Management (http://www.allmedmd.com), a leading Independent Review Organization (IRO). "Many doctors are uncertain about the best way to screen for the disease or which patients to screen."

As a result, doctors either unnecessarily screen patients or order expensive and unneeded medical tests. This unneeded screening can result in an increased number of false-positive results. Following up on them often means invasive testing. These extra tests have both an inherent risk and increase the cost of treatment.

For a screening to be medically required, one of these conditions must exist:

    -- The patient is over 65-years old and diagnosed with high blood pressure
       (hypertension) for the first time.
    -- The patient has medically controlled blood pressure that is worsening.
    -- The patient has an acute kidney injury.
    -- The patient has a chronic kidney disease that's not explained by
       diabetes, volume depletion or some form of vascular disease.

This approach excludes routine screenings for renal artery stenosis in low risk hypertensive patients -- for example, a significantly obese young patient with no vascular disease, who also doesn't have other diseases, such as diabetes or sleep apnea would not need screening. The inability to control a patient's hypertension who is not
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SOURCE AllMed Healthcare Management
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