Evaluation of duplex ultrasound and captopril renography for detection of renovascular hypertension.
BACKGROUND
Renovascular hypertension is the most common form of curable secondary hypertension and, if untreated, may lead to end-stage kidney disease. Given that renal function and hypertension may improve after renal angioplasty, it is pertinent to identify patients with renal artery stenosis. The aim of the present study was to evaluate both duplex ultrasound and captopril renography for detection of renal artery stenosis among hypertensive patients.


METHODS
To avoid selection bias, all patients referred to our center for evaluation of renovascular hypertension were asked to participate in the study. Patients were examined by intra-renal duplex ultrasound (N = 121), measuring pulsatility index and acceleration of the blood flow during early systole. In 98 patients, 99mTc-DTPA captopril renography was performed in conjunction with duplex ultrasound. Renal angiography was performed in all patients regardless of the results of the noninvasive tests.


RESULTS
The prevalence of renal artery stenosis was 19%. In the 98 patients examined by both duplex ultrasound and captopril renography, sensitivity and positive predictive values for detection of a renal artery stenosis of 50% degree or more were 84 and 76%, respectively, for duplex ultrasound, whereas captopril renography was associated with a sensitivity and positive predictive value of 68% for both (P = NS). Specificity and negative predictive values were 94 and 96%, respectively, for duplex ultrasound, whereas the corresponding values for captopril renography were 92% for both (P = NS). Specificity and negative predictive values were 94 and 96%, respectively, for duplex ultrasound, whereas the corresponding values for captopril renography were 92% for both (P = NS).


CONCLUSIONS
Both duplex ultrasound and captopril renography are associated with high specificity and negative predictive values for detection of renal artery stenosis. Sensitivity and positive predictive values are at least as good for duplex ultrasound compared with captopril renography. Given that duplex ultrasound is easier to perform and more cost effective, we propose that it should be the method of first choice when screening for renal artery stenosis in a hypertensive population.
Departments of Clinical Physiology, Nephrology and Radiology, Göteborg University, Sahlgrenska University Hospital, Sweden. m.johansson@medfak.gu.se
M
M
Johansson
G
G
Jensen
M
M
Aurell
P
P
Friberg
H
H
Herlitz
H
H
Klingenstierna
R
R
Volkmann
D000806:Angiotensin-Converting Enzyme Inhibitors; D001783:Blood Flow Velocity; D002216:Captopril; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006801:Humans; D006977:Hypertension, Renal / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011866:Radioisotope Renography; D019275:Radiopharmaceuticals; D012078:Renal Artery Obstruction / Q000000981:diagnostic imaging; D012079:Renal Circulation; D012680:Sensitivity and Specificity; D016284:Technetium Tc 99m Pentetate; D018616:Ultrasonography, Doppler, Duplex
D000806:Angiotensin-Converting Enzyme Inhibitors; D019275:Radiopharmaceuticals; D002216:Captopril; D016284:Technetium Tc 99m Pentetate