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Evaluation of renovascular hypertension
M L Middleton1, J A Bongiovanni, M D Blaufox
1Albert Einstein College of Medicine, Bronx, NY.
Current Opinion in Nephrology and Hypertension
|November 1, 1993
Summary
Evaluating renovascular hypertension involves many tests, each with pros and cons. Captopril renal scintigraphy is an excellent initial screening test, offering diagnostic and prognostic insights for this condition.
Area of Science:
- Nephrology
- Cardiology
- Radiology
Background:
- Renovascular hypertension diagnosis requires effective screening tests.
- Numerous nonimaging and imaging tests exist, each with limitations.
- Accurate screening is crucial for timely intervention.
Purpose of the Study:
- To review and compare various diagnostic tests for renovascular hypertension.
- To identify the most effective screening methods.
- To discuss the advantages and disadvantages of each test.
Main Methods:
- Review of nonimaging tests: peripheral plasma renin activity, captopril test, renal vein renin sampling.
- Evaluation of anatomic imaging: intravenous urography, magnetic resonance angiography, contrast angiography.
- Assessment of physiologic imaging: Doppler sonography, captopril renal scintigraphy.
Main Results:
- Nonimaging tests have inherent limitations.
- Intravenous urography is less accurate; MRI is costly.
- Contrast angiography is the gold standard but invasive and expensive.
- Doppler sonography is operator-dependent but useful for renal transplants.
- Captopril renal scintigraphy is an excellent initial screening test.
Conclusions:
- Captopril renal scintigraphy provides valuable diagnostic and prognostic information.
- No single test is perfect; a combination or tailored approach may be needed.
- Selecting the appropriate screening test depends on clinical context and resource availability.