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Pre- and postcaptopril renal scintigraphy as a screening test for renovascular hypertension in children

Sameh Abdulsamea1, Peter Anderson, Lorenzo Biassoni

  • 1Department of Paediatric Nephrology, Benha University Hospital, Benha, Egypt.

Pediatric Nephrology (Berlin, Germany)
|September 17, 2009
PubMed

Insights

Pre- and postcaptopril renal scintigraphy showed limited accuracy in predicting renovascular disease (RVD) in children. The imaging technique demonstrated low sensitivity and negative predictive value for diagnosing RVD in pediatric patients.

Area of Science:

  • Pediatric Nephrology
  • Diagnostic Imaging
  • Nuclear Medicine

Background:

  • Renovascular disease (RVD) is a significant cause of secondary hypertension in children.
  • Accurate diagnosis of RVD is crucial for timely intervention and management.
  • Captopril renography is a non-invasive imaging technique used to assess renal artery stenosis.

Purpose of the Study:

  • To evaluate the diagnostic performance of pre- and postcaptopril renal scintigraphy in predicting renovascular disease (RVD) in a pediatric population.
  • To determine the sensitivity, specificity, and predictive values of this imaging modality for RVD detection.

Main Methods:

  • Retrospective review of medical records and radiology reports of hypertensive children who underwent both pre- and postcaptopril renal scintigraphy.
  • Scintigraphy utilized technetium-99m dimercaptosuccinic acid (DMSA) and/or technetium-99m mercaptoacetyltriglycine (MAG3).
  • Digital subtraction angiography (DSA) served as the gold standard for RVD confirmation.

Main Results:

  • A total of 81 children (aged 1-18 years) were included, with 62% diagnosed with RVD.
  • The isotope study accurately diagnosed RVD in 47% of confirmed cases, with eight false positives.
  • Sensitivity was 48%, specificity 73%, positive predictive value 76%, and negative predictive value 51%.

Conclusions:

  • Pre- and postcaptopril renal scintigraphy demonstrated suboptimal accuracy in predicting renovascular disease in children.
  • The low sensitivity and negative predictive value suggest this method is unreliable for excluding RVD in pediatric hypertension.
  • Further investigation into more accurate diagnostic tools for pediatric RVD is warranted.

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