During a routine medical checkup, Shelby, a 26-year-old physiotherapy student, is surprised to hear that her blood pressure is 180/110. She also has a rumbling systolic and diastolic abdominal bruit (murmur) that is loudest at the mid-epigastric area. Her physician suspects renal artery stenosis (narrowing). She orders an abdominal ultrasound and renal artery arteriography, which confirm that Shelby has a small right kidney and the distal part of her right renal artery is narrowed by more than 70%. Her physician prescribes diuretics and calcium channel blockers as temporary measures, and refers Shelby to a cardiovascular surgeon. Explain the connection between Shelby’s renal artery stenosis and her hypertension. Why is her right kidney smaller than her left? What would you expect Shelby’s blood levels of K+ , Na+ , aldosterone, angiotensin II, and renin to be?
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