Abdominal Murmurs, an Aid in the Diagnosis of Renal Artery Disease in Hypertension

Abstract

Auscultation of the upper abdomen of all patients with hypertension was performed during a 5-month period. The location and character of all murmurs was recorded. Of many patients with murmurs, 50 were selected for translumbar renal arteriography because of criteria cited by Howard, Poutasse and Dustan. Thirty-three (66%) of patients selected for arteriography had renal artery disease (predominantly stenosis). Seventeen (51%) of these patients had the onset of hypertension between the ages of 30-50. Twenty-five (75%) had a family history of either stroke, heart attack or hypertension. Eleven had a serum creatinine of 1.3 mg % or above and 29 of the 33 had ecg evidence of LVH. A high pitch murmur was present in 15 of the 50 cases. Thirteen (87%) of these 15 had renal artery disease. Of 21 cases who had a loud murmur, 17 (81%) had renal artery disease. Five patients had continuous murmurs, and all of these had significant renal artery disease. In 6 cases of unilateral renal artery disease, accurate localization of the lesion by auscultation was possible. Intravenous pyelography was done in 29 cases of renal artery disease and was normal in 13 (45%). An I131 hippuran renogram was done in 30 cases, and 7 (23%) were normal. The pathophysiology of vascular murmurs is discussed. The presence of a high pitch, loud, continuous upper abdominal murmur in a patient with severe hypertension is almost pathognomonic for renal artery disease.