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Ratnam et al take a one sided radiological view of investigating progressive unexplained renal impairment and hypertension—a hotly debated topic in nephrology.1 Many small studies have investigated whether renal artery angioplasty is better than medical intervention, and none is conclusive either way. The risks from angioplasty have not been mentioned (renal artery occlusion and silent loss of the kidney). An ongoing randomised trial (Astral) will hopefully answer this question.
The authors also comment on a “high level of cholesterol,” but this does not equate to the British Hypertension Society guidelines of measuring 10 year risk. The authors also make no comment on the antihypertensive drugs the patient was taking (such as angiotensin converting enzyme inhibitors and angiotensin II receptor blockers), which are often the main cause of deterioration in renal function. Stopping these will often stop the rise in creatinine concentrations and sometimes result in slow improvement in creatinine over the next couple of months.
Competing interests: None declared.