Nephrology Q 18

A 57-year-old man is evaluated during a follow-up visit for stable chronic kidney disease diagnosed 1 year ago. Renal duplex Doppler ultrasound at that time showed a 7-cm right kidney and 11-cm left kidney with a >75% midstenotic lesion of the left renal artery. He also has type 2 diabetes mellitus, hyperlipidemia, and peripheral artery disease. Medications are low-dose aspirin, furosemide, lisinopril, amlodipine, carvedilol, metformin, empagliflozin, and atorvastatin. On physical examination, blood pressure is 128/74 mm Hg, pulse rate is 65/min, and respiration rate is 18/min. Bilateral carotid and lower abdominal quadrant bruits are heard. Peripheral extremity pulses are diminished. The remainder of the examination is normal.

Which of the following is the most appropriate management?

A Left renal artery angioplasty

B Renal artery CT angiography

C Renal artery MR angiography

D No additional diagnostic testing

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