Limited use of hypertensive excretory urography

Clinical experience indicates that hypertensive excretory urography is not a satisfactory screening examination to detect patients having hypertension due to renal artery stenosis. Review of the Cooperative Study data indicates the false negative rate for screening was 21.8%. In addition, the prevalence of hypertension caused by renal artery stenosis appears quite low, in the range of 1-3%. Since the objective is to identify patients who will benefit from surgery, clinical sorting strategy should focus on evaluating patients as surgical candidates, not as having the disease. Once that is done, pharmacodynamic renal arteriography is recommended as the first imaging examination to find the renal artery lesion and determine its hemodynamic significance.