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Diagnostic imaging evaluation of renovascular hypertension

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Abstract

Over 50 million people in the United States are hypertensive. Renovascular disease accounts for 3–5% of these hypertensive patients. Because renovascular hypertension is potentially curable, much effort has been devoted to detecting and treating renal artery stenosis. Conventional angiography has been traditionally used to diagnose renal artery stenosis. However, because of its invasiveness and cost, conventional angiography cannot be utilized as a screening test in all patients who may have renal artery stenosis. Several noninvasive studies have been advocated for screening in hypertensive patients who may have renovascular disease. However, the accuracy of these noninvasive studies is widely variable, and appropriate use of these noninvasive studies needs to be better defined. Appropriate use of diagnostic imaging examinations for hypertensive patients depends on the index of suspicion for renovascular disease and on the patient's renal function. If certain clinical findings suggest the possibility of renovascular disease, then conventional angiography/intraarterial digital subtraction angiography should be performed. Captopril renography or duplex Doppler sonography could also be utilized if angiography is not desired or is contraindicated because of impaired renal function or a contrast allergy. Magnetic resonance angiography appears to be most helpful in a small, select group of patients who are likely to have proximal renal artery stenosis.

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References

  1. Massry SG, Glasscock RJ, eds.Textbook of nephrology, 2nd ed., 1989:139–140

  2. Harrison EG, McCormack LJ. Pathologic classification of renal arterial disease in renovascular hypertension.Mayo Clin Proc 1971;46:161–167

    Google Scholar 

  3. Subcommittee on Definition and Prevalence of the 1984 Joint National Committee. Hypertension prevalence and the status of awareness, treatment, and control in the United States (final report).Hypertension 1985;7:457

    Google Scholar 

  4. Veterans Administration Cooperative Study Group on Antihypertensive Agents. Effects of treatment of morbidity in hypertension: results in patients with diastolic blood pressures averaging 115 through 129 mmHg.JAMA 1967;202:1028

    Google Scholar 

  5. Working Group on Renovascular Hypertension. Final report of the Working Group on Renovascular Hypertension.Arch Intern Med 1987;147:820

    Google Scholar 

  6. Vaughan ED, Buhler FR, Laragh JH, Sealey JE, Baer L, Bard RH. Renovascular hypertension: renin measurements to indicate hypersecretion and contralateral suppression, estimate renal plasma flow, and score for surgical curability.Am J Med 1973;55:402–414

    Google Scholar 

  7. Hillman BJ, Oviatt TW, Capp MP, Fisher HD, Frost MM, Nudelman S. Renal digital subtraction angiography: 100 cases.Radiology 1982;145:643–646

    Google Scholar 

  8. Pickering TG, Sos TA, Vaughan ED, et al. Predictive values and changes of renin secretion in hypertensive patients with unilateral renovascular disease undergoing successful angioplasty.Am J Med 1984;76:398–404

    Google Scholar 

  9. Roubidoux MA, Dunnick NR, Klotman PE, Newman GE, Cohan RH, Kadir S, Svetkey LP. Renal vein renins: inability to predict response to revascularization in patients with hypertension.Radiology 1991;178:819–822

    Google Scholar 

  10. Illescas FF, Ford K, Braun SD, Dunnick NR. Intra-arterial digital subtraction angiography in hypertensive azotemic patients.AJR 1984;143:1065–1067

    Google Scholar 

  11. Norman D, Ulloa N, Brant-Zawadzki M, Gould RG. Intra-arterial digital subtraction imaging cost considerations.Radiology 1985;156:33–35

    Google Scholar 

  12. Bookstein JJ, Abrams HL, Buenger RE, Reiss MD, Lecky JW, Franklin SS, Bleifer KH, Varady PD, Maxwell MH. Radiologic aspects of renovascular hypertension. 1. Aims and methods of the radiology study group.JAMA 1972;220:1195–1204

    Google Scholar 

  13. Bookstein JJ, Abrams HL, Buenger RE, Reiss MD, Lecky JW, Franklin SS, Bleifer KH, Varady PD, Maxwell MH. Radiologic aspects of renovascular hypertension. 2. The role of urography in unilateral renovascular disease.JAMA 1972;220:1209–1230

    Google Scholar 

  14. Bookstein JJ, Abrams HL, Buenger RE, Reiss MD, Lecky JW, Franklin SS, Bleifer KH, Varady PD, Maxwell MH. Radiologic aspects of renovascular hypertension. 3. Appraisal of arteriography.JAMA 1972;21:368–378

    Google Scholar 

  15. Bookstein JJ, Abrams HL, Buenger RE, Reiss MD, Lecky JW, Franklin SS, Bleifer KH, Varady PD, Maxwell MH. Radiologic aspects of renovascular hypertension. 4. Arteriographic complications.JAMA 1972;21

  16. Thornbury JR, Stanley JC, Fryback DG. Hypertensive urogram: a nondiscriminatory test for renovascular hypertension.AJR 1982;138:43–49

    Google Scholar 

  17. Clark RA, Alexander ES. Digital subtraction angiography of the renal arteries: prospective comparison with conventional arteriography.Invest Radiol 1983;18:6–10

    Google Scholar 

  18. Wilms GE, Baert AL, Staessen JA, Amery AK. Renal artery stenosis: evaluation with intravenous digital subtraction angiography.Radiology 1986;160:713–715

    Google Scholar 

  19. Hillman B. Imaging advances in the diagnosis of renovascular hypertension.AJR 1989;153:5–14

    Google Scholar 

  20. Dunnick NR, Svetkey LP, Cohan RH, Newman GE, Braun SD, Himmelstein SI, Bollinger RR, McCann RL, Wilkinson RH, Klotman PE. Intravenous digital subtraction renal angiography: use in screening for renovascular hypertension.Radiology 1989;171: 219–222

    Google Scholar 

  21. Taylor DC, Kettler MD, Moneta GL, Kohler TR, Kazmers A, Beach KW, Strandness DE. Duplex ultrasound scanning in the diagnosis of renal artery stenosis: a prospective evaluation.J Vasc Surg 1988;7:363–369

    Google Scholar 

  22. Postma CT, van Aalen J, de Boo T, Rosenbusch G, Thien T. Doppler ultrasound scanning in the detection of renal artery stenosis in hypertensive patients.Br J Radiol 1992;65:857–860

    Google Scholar 

  23. Bardelli M, Jensen G, Volkmann R, Aurell M. Non-invasive ultrasound assessment of renal artery stenosis by means of the Gosling pulsatility index.J Hyperten 1992;10:985–989

    Google Scholar 

  24. Desberg AL, Paushter DM, Lammert GK, Hale JC, Troy RB, Novick AC, Nally JV, Weltevreden AM. Renal artery stenosis: evaluation with color Doppler flow imaging.Radiology 1990;177:749–753

    Google Scholar 

  25. Kohler TR, Zierler RE, Martin RL, Nicholls SC, Bergelin RO, Kazmers A, Beach KW, Strandness DE. Noninvasive diagnosis of renal artery stenosis by ultrasonic duplex scanning.J Vasc Surg 1986;4:450–456

    Google Scholar 

  26. Robertson R, Murphy A, Dubbins PA. Renal artery stenosis: the use of duplex ultrasound as a screening technique.Br J Radiol 1988;61:196–201

    Google Scholar 

  27. Berland LL, Koslin DB, Routh WD, Keller FS. Renal artery stenosis: prospective evaluation of diagnosis with color duplex ultrasound compared with angiography.Radiology 1990;174:421–423

    Google Scholar 

  28. Stavros AT, Parker SH, Yakes WF, Chantelois AE, Burke BJ, Meyers PR, Schenck JJ. Segmental stenosis of the renal artery: pattern recognition of tardus and parvus abnormalities with duplex sonography.Radiology 1992;184:487–492

    Google Scholar 

  29. Chen CC, Hoffer PB, Vahjen G, Gottschalk A, Koster K, Zubal IG, Setaro JF, Roer DA, Black HR. Patients at high risk for renal artery stenosis: a simple method of renal scintigraphic analysis with Tc-99m DTPA and Captopril.Radiology 1980;176:365–370

    Google Scholar 

  30. Russell CD, Thorstad B, Yester MV, Stutzman M, Baker T, Dubovsky EV. Comparison of technetium-99m MAG3 with iodine- 131 Hippuran by simultaneous dual channel technique.J Nucl Med 1988;29:1189–1193

    Google Scholar 

  31. Sfakianakis GN, Bourgoignie JJ, Jaffe D, Kyriakides G, Perez-Stable E, Duncan RC. Single-dose Captopril scintigraphy in the diagnosis of renovascular hypertension.J Nucl Med 1987;28:1383–1392

    Google Scholar 

  32. Setaro JF, Chen CC, Hoffer PB, Black HR. Captopril renography in the diagnosis of renal artery stenosis and the prediction of improvement with revascularization: the Yale Vascular Center experience.Am J Hypertens 1991;4:698S-705S

    Google Scholar 

  33. Postma CT, van Oijen AHAM, Barentsz JO, deBoo T, Hoefnagels WHL, Corstens FHM, Thien T. The value of tests predicting renovascular hypertension in patients with renal artery stenosis treated by angioplasty.Arch Intern Med 1991;151:1531–1535

    Google Scholar 

  34. Mann SJ, Pickering TG, Sos TA, Uzzo RG, Sarkar S, Friend K, Rackson ME, Laragh JH. Captopril renography in the diagnosis of renal artery stenosis: accuracy and limitations.Am J Med 1991;90:30–40

    Google Scholar 

  35. Dondi M, Monetti N, Fanti S, Marchetta F, Corbelli C, Zagni P, De Fabritis A, Losinno F, Levorato M, Zuccala A. Use of technetium-99m-MAG3 for renal scintigraphy after angiotensin-converting enzyme inhibition.J Nucl Med 1991;32:424–428

    Google Scholar 

  36. Kletter K, Mostbeck G, Dudczak R. Captopril renography and duplex sonography: comparison of two noninvasive methods for the diagnosis and follow-up in renovascular hypertension. In: Blaufox MD, Hollenberg NK, Raynaud C, eds.Radionuclides in nephro-urology, vol. 79. Basel; Karger. 1990:190–195

    Google Scholar 

  37. Davidson RA, Wilcox CS. Newer tests for the diagnosis of renovascular disease.JAMA 1992;268:3353–3358

    Google Scholar 

  38. Erbsloh-Moller B, Dumas A, Roth D, et al. Furosamide I-131 Hippuran renography after ACE inhibition for the diagnosis of renovascular hypertension.Am J Med 1991;90:23–29

    Google Scholar 

  39. Dondi M, Fanti S, DeFabritus A. Prognostic value of captopril renal scintigraphy in renovascular hypertension.J Nucl Med 1992;33:2040

    Google Scholar 

  40. Kim D, Edelman R, Kent K, Porter D, Skillman JJ. Abdominal aorta and renal artery stenosis: evaluation with MR angiography.Radiology 1990;174:727–731

    Google Scholar 

  41. Debatin J, Spritzer C, Grist TM, Beem C, Svetkey LP, Newman GE, Sostman HD. Imaging of the renal arteries: value of MR angiography.AJR 1991;157:981–990

    Google Scholar 

  42. Loubeyre P, Revel D, Garcia P, Delignette A, Canet E, Chirossel P, Genin G, Amiel M. Screening patients for renal artery stenosis: value of three-dimensional time-of-flight MR angiography.AJR 1994;162:847–852

    Google Scholar 

  43. Yucel EK, Kaufman JA, Prince M, Bazari H, Fang LST, Waltman AC. Time-of-flight renal MR angiography: utility in patients with renal insufficiency.Mag Res Imaging 1993;11: 925–930

    Google Scholar 

  44. Grist TM, Kennell TW, et al. Prospective evaluation of renal MR angiography: comparison with conventional angiography in 35 patients. RSNA 1993

  45. Farrugia E, King BF, Larson TS. Magnetic resonance angiography and detection of renal artery stenosis in a patient with impaired renal function.Mayo Clin Proc 1993;68:157–160

    Google Scholar 

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  1. Department of Diagnostic Radiology, Mayo Clinic and Mayo Foundation, 200 First Street, SW, 55905, Rochester, MN, USA

    B. F. King Jr.

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King, B.F. Diagnostic imaging evaluation of renovascular hypertension. Abdom Imaging 20, 395–405 (1995). https://doi.org/10.1007/BF01213259

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