On admission to the hospital, her blood pressure was 200/108 mmHg with no remarkable differences between all four extremities. ESR was 35 mm/hr, compared to a baseline of 7 mm/hr. Her complete blood count was unremarkable. Potassium was 5.1 mmol/L with a creatinine of 3.95 mg/dL. Urinalysis revealed an absence of red and white blood cells, and a urine protein to creatinine ratio was 0.47. Renin activity and aldosterone were both elevated at 52 pg/mL and 46.6 ng/dL respectively with a normal ratio, suggestive of renovascular disease. Duplex ultrasound was a limited study showing decreased flow in the right kidney, which appeared atrophic. Flow velocities were elevated in the left renal artery. An MRA without gadolinium revealed wall thickening of the abdominal aorta most prominent at the level of the superior mesenteric artery (SMA) extending to below the location of the renal arteries with wall thickening of the proximal SMA and left renal artery (see Figure 3). The right renal artery was diminutive with atrophy of the right kidney, similar to studies in 2011.