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Renal vein renins: inability to predict response to revascularization in patients with hypertension
M A Roubidoux1, N R Dunnick, P E Klotman
1Department of Radiology, Duke University Medical Center, Durham, NC 27710.
Insights
The captopril-stimulated renal vein renin ratio (CSRVRR) is not a reliable indicator for identifying patients with renovascular hypertension who will benefit from revascularization. Its low sensitivity and specificity limit its clinical utility in predicting treatment response.
Area of Science:
- Nephrology
- Cardiology
- Hypertension Research
Background:
- Renovascular hypertension poses diagnostic challenges.
- Identifying patients who will benefit from revascularization is crucial for effective treatment.
Purpose of the Study:
- To evaluate the diagnostic accuracy of the captopril-stimulated renal vein renin ratio (CSRVRR) in identifying hemodynamically significant renovascular lesions.
- To determine if CSRVRR can predict patient response to revascularization therapy.
Main Methods:
- Prospective study involving 143 hypertensive patients with suspected renovascular hypertension.
- Measurement of CSRVRR and conventional renal arteriography.
- Diagnosis of renovascular hypertension based on response to revascularization.
Main Results:
- CSRVRR > 1.5 had a sensitivity of 65% and a false-positive rate of 47.8% for renovascular hypertension.
- Positive predictive value was 18.6%, and negative predictive value was 89.3%.
- CSRVRR did not reliably predict response to revascularization.
Conclusions:
- CSRVRR is not sufficiently sensitive or specific for predicting response to revascularization in renovascular hypertension.
- The diagnostic performance of CSRVRR is inadequate for clinical decision-making in this patient population.
Abstract:
To determine whether the captopril-stimulated renal vein renin ratio (CSRVRR) could enable identification of patients with hemodynamically significant renovascular lesions who would respond to revascularization, the authors measured CSRVRRs in 143 consecutive patients with hypertension who had been selected because of clinical features suggestive of renovascular hypertension. All patients underwent conventional renal arteriography. Renovascular hypertension was the final diagnosis if revascularization resulted in cure or improvement in blood pressure. Complete data were available for 133 patients. Twenty patients had renovascular hypertension; CSRVRR was greater than 1.5 in 13 of these 20 patients (sensitivity, 65%). However, it was also greater than 1.5 in 54 of the 113 patients without renovascular hypertension (false-positive rate, 47.8%). The positive predictive value of CSRVRR was 18.6%; the negative predictive value, 89.3%. It is concluded that CSRVRR is not sufficiently sensitive to enable prediction of which patients will respond to revascularization and is not specific enough to exclude patients who do not have renovascular hypertension.