Captopril renal scintigraphy in a patient with bilateral renal artery stenosis

A 41-yr-old woman with bilateral renal artery stenosis (RAS) and renovascular hypertension is presented. In this patient, the routine [99mTc]diethylenetriaminepentaacetic acid renal scintigraphy without Captopril was normal and the subsequent study with Captopril showed a marked decrease in glomerular filtration rate of the right kidney alone. Percutaneous transluminal angioplasty of the functionally affected right kidney immediately evoked new renin-dependent hypertension caused by the untreated left RAS. This patient illustrates two major points: (a) as a diagnostic tool, the sensitivity of Captopril renal scintigraphy may be compromised by an inability to detect bilateral RAS, but (b) after angioplasty, it can be useful for evaluating the treated kidney and in revealing contralateral disease that may benefit from angioplasty.