24th June 2023

A 61-year-old Caucasian man is referred to nephrology clinic due to progressively worsening renal function.

A 61-year-old Caucasian man is referred to nephrology clinic due to progressively worsening renal function. Serum creatinine was 70μmol/L two years ago, it was noted to be 110μmol/L on an NHS Health Check last month and rose to 150μmol/L on repeat testing (normal range 60-100μmol/L). The health check identified hypertension for which he was started on an antihypertensive. He was also given smoking cessation advice due to a 30-pack-year smoking history.

Clinical examination reveals a raised BMI, blood pressure of 141/95mmHg, a right-sided renal bruit and bilateral femoral artery bruits. Urine dip is bland. An ultrasound of the renal tract shows asymmetrical kidneys (right smaller than left) and no obstruction.

What is the most likely cause of the renal impairment given the findings above?