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Parenchymal renal diseases
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Urinary tract infection or obstruction, analgesic abuse, familial history of polycystic kidney disease
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Abdominal mass (polycystic kidney disease)
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Proteinuria, hematuria, pyuria, reduced glomerular filtration rate
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Renal US
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Further studies for kidney diseases
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Renal artery stenosis
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Fibromuscular dysplasia, premature hypertension (female), atherosclerotic diseases, sudden onset or worsening of hypertension, resistant hypertension, recurrent pulmonary edema
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Abdominal bruit
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Rapid worsening of renal function (spontaneous or after ACE inhibitor or ARB treatment)
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Kidney size difference >1.5 cm, duplex Doppler US, CT
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Magnetic resonance imaging, digital subtraction angiography
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Primary aldosteronism
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Muscle weakness, premature hypertension, familial history of premature stroke (<40 years old)
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Arrhythmia (severe hypokalemia)
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Hyperkalemia (spontaneously or after treatment by ACE inhibitor or ARB), incidental adrenal mass
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Aldosterone renin ratio (after correction of hypokalemia and disappeared effect of ACE inhibitor or ARB)
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Suppression test by saline infusion, fludrocortisone, and/or captopril, adrenal CT, adrenal vein sampling
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Pheochromo-cytoma
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Paroxysmal hypertension, emergency visit by persistent hypertension with headache, sweat, and/or pallor, familial history
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Café-au-lait lesion and neurofibro-matosis neurofibroma
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Incidental adrenal mass (extraadrenal mass in some cases)
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Metanephrine and/or nor-metanephrine in 24-h urine
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Abdominal and/or pelvic CT or magnetic resonance imaging, radioisotope scan using meta-iodobenzyl-guanidine
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Cushing syndrome
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Rapid weight gain, polyuria, polydipsia, psychiatric problems
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Central obesity, mood face, buffalo hump, abdominal striae, hirsutism
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Hyperglycemia
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Cortisol in 24-h urine
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Dexamethasone suppression test
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