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Renal duplex sonography: evaluation of clinical utility
K J Hansen1, R W Tribble, S W Reavis
1Department of Medicine, Bowman Gray School of Medicine, Wake Forest University, Winston-Salem, NC 27103.
Journal of Vascular Surgery
|September 1, 1990
Summary
Renal duplex sonography shows high accuracy in screening for renovascular disease, identifying 93% of cases with single renal arteries. This non-invasive test is valuable for detecting correctable conditions causing renal insufficiency.
Area of Science:
- Nephrology
- Vascular Surgery
- Diagnostic Imaging
Background:
- Accurate screening for renovascular disease is crucial for managing hypertension and renal insufficiency.
- Conventional angiography, while definitive, is invasive and not ideal for initial screening.
- Renal duplex sonography offers a non-invasive alternative for evaluating renal artery stenosis.
Purpose of the Study:
- To evaluate the diagnostic value and accuracy of renal duplex sonography as a screening tool for correctable renovascular disease.
- To compare renal duplex sonography findings with conventional angiography in a patient cohort.
- To assess the test's performance in patients with varying degrees of renal insufficiency and anatomical variations.
Main Methods:
- A prospective analysis of 74 patients undergoing 77 comparative renal duplex sonography and conventional angiography studies.
- Inclusion of patients with severe renal insufficiency, hypertension, and multiple renal arteries.
- Calculation of sensitivity, specificity, positive predictive value, negative predictive value, and overall accuracy for renal duplex sonography.
Main Results:
- Renal duplex sonography demonstrated high diagnostic accuracy (96%) in identifying renovascular disease in kidneys with single renal arteries (93% sensitivity, 98% specificity).
- The test correctly identified disease in 41 of 44 patients with angiographically proven lesions and correctly excluded disease in unaffected patients.
- Diagnostic accuracy was reduced in kidneys with multiple (polar) renal arteries. Low end diastolic ratio did not preclude positive outcomes after reconstruction.
Conclusions:
- Renal duplex sonography is a valuable screening tool for detecting correctable renovascular disease causing global renal ischemia and secondary renal insufficiency.
- The modality is less effective for identifying polar vessel disease or predicting treatment response.
- Further investigation may be needed for complex renal artery anatomies and treatment outcome prediction.