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Losartan renography for the detection of renal artery stenosis: comparison with captopril renography and evaluation of dose and timing

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European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

Abstract

Purpose

Radionuclide renography with angiotensin converting enzyme (ACE) inhibition plays an important role in the diagnosis of haemodynamically significant renal artery stenosis. Angiotensin receptor antagonists inhibit the renin angiotensin system at different levels from ACE inhibitors by selectively blocking the binding of angiotensin II to AT1 receptors. The AT1 angiotensin receptor antagonist losartan has recently been used clinically in the treatment of hypertension. However, the available data on the use of losartan with renography for the detection of renovascular hypertension are limited and contradictory. The purpose of this prospective study was to compare the effectiveness of losartan renography and captopril scintigraphy in revealing renal artery stenosis.

Methods

A total of 61 renal units in 32 patients with hypertension were studied in two groups based on the losartan dosage (50 mg in group A and 100 mg in group B). Group A consisted of 17 patients, in whom 19 renal units had angiographically proven renal artery stenosis (≥50%). In group B, there were 15 patients, in whom 20 renal arteries were stenotic. All of the patients underwent three renographies (baseline, captopril renography and early losartan renography). Early losartan renography was performed at 1 h after oral losartan administration in both groups. In group B, seven patients underwent additional losartan renography (late losartan) performed 3 h after oral losartan administration; these patients composed group B1.

Results

The sensitivities of captopril and losartan studies were 63.2% and 42% in group A, 65% and 65% in group B and 55.6% and 66.6% in group B1, respectively.

Conclusion

From our preliminary results, we conclude that losartan is not superior to captopril renography for the detection of haemodynamically significant renal artery stenosis. However, a high dose (100 mg) of losartan provided higher sensitivity than the lower dose (50 mg). Late losartan scintigraphy provided similar diagnostic efficacy to early losartan renography.

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References

  1. Ergun EL, Caglar M, Erdem Y, Usalan C, Ugur O, Duranay M. Tc-99m DTPA acetylsalicylic acid (aspirin) renography in the detection of renovascular hypertension. Clin Nucl Med 2000;25 9:682–90.

    CAS  PubMed  Google Scholar 

  2. Liepe K, Seeman A, Gross P, Kropp J, Franke WG. Losartan in the interventional renography of renovascular hypertension [abstract]. J Nucl Med Suppl 1999;40 5:93P.

    Google Scholar 

  3. Karanikas G, Becherer A, Wiesner K, Dudczac R, Kletter K. ACE inhibition is superior to angiotensin receptor blockade for renography in renal artery stenosis. Eur J Nucl Med Mol Imaging 2002;29 3:312–8.

    CAS  PubMed  Google Scholar 

  4. Fuster D, Marco MP, Setoain FJ, Oppenheimer F, Lomena F. A case of renal artery stenosis after transplantation: can losartan be more accurate than captopril renography? Clin Nucl Med 1998;23 11:731–4.

    CAS  PubMed  Google Scholar 

  5. Song LP, Liu XJ, Shi RF, He ZX, Tian YQ, Zhang XL, et al. Comparison between captopril and losartan Tc-99m-EC renography in detecting renovascular hypertension (abstract). J Nucl Med 2003;44 5 Suppl:144P.

    Google Scholar 

  6. Physicians Desk Reference, 55th edn. Medical Economics Company; 2001:1902–4.

  7. Laverman GD, Navis G, Henning RH, De Jong PE, De Zeeuw D. Dual renin angiotensin system blockade at optimal doses for proteinuria. Kidney Int 2002;62:1020–5.

    CAS  PubMed  Google Scholar 

  8. Taylor AT Jr, Fletcher JW, Nally JV Jr, Blaufox MD, Dubovsky EV, Fine EJ, et al. Procedure guideline for diagnosis of renovascular hypertension. J Nucl Med 1998;39:1297–302.

    PubMed  Google Scholar 

  9. Taylor A, Nally J, Aurell M, Blaufox D, Dondi M, Dubovsky E, et al. Consensus report on ACE inhibitor renography for detecting renovascular hypertension. J Nucl Med 1996;37 11:1876–82.

    PubMed  Google Scholar 

  10. Taylor A. Renovascular hypertension: nuclear medicine techniques. Q J Nucl Med 2002;46:268–82.

    CAS  PubMed  Google Scholar 

  11. Perazella MA, Setaro JF. Renin–angiotensin–aldosterone system: fundamental aspects and clinical implications in renal and cardiovascular disorders. J Nucl Cardiol 2003;10 2:184–96.

    PubMed  Google Scholar 

  12. Wolf G, Butzmann U, Wenzel UO. The renin–angiotensin system and progression of renal disease: from hemodynamics to cell biology. Nephron Physiol 2003;93:3–13.

    Google Scholar 

  13. Weir MR, Henrich WL. Theoretical basis and clinical evidence for differential effects of angiotensin converting enzyme inhibitors and angiotensin II receptor subtype 1 blockers. Curr Opin Nephrol Hypertens 2000;9:403–11.

    CAS  PubMed  Google Scholar 

  14. Ren Y, Garwin J, Carreter OA. Mechanism involved in bradykinin induced efferent arteriole dilatation. Kidney Int 2002;62:544–9.

    CAS  PubMed  Google Scholar 

  15. Kon V, Fogo A, Ichikawa I. Bradykinin causes selective arteriolar dilatation during angiotensin I converting enzyme inhibition. Kidney Int 1993;44:545–50.

    CAS  PubMed  Google Scholar 

  16. Gansevoort RT, Zeeuw D. The antihypertensive and renal effects of angiotensin II receptor antagonists: remaining questions. Curr Opin Nephrol Hypertens 2000;9:57–61.

    CAS  PubMed  Google Scholar 

  17. Ritter JM, Coccroft JR, Sciberras DG, Goldberg MR. Clinical pharmacology of angiotensin and bradykinin in human forearm vasculature. J Hypertens. 1993;11 Suppl 3:559–61.

    PubMed  Google Scholar 

  18. Berlowitz MS, Latif F, Hankins SR, Ennezat PV, Moskowitz R, Tandon S, et al. Dose-dependent blockade of the angiotensin II type 1 receptor with losartan in normal volunteers. Cardiovasc Pharmacol 2001;37 6:692–6.

    CAS  Google Scholar 

  19. Picciotto G, Sargiotto A, Petrarulo M, Rabbia C, De Filipi G, Roccatello D. Reliability of captopril renography in patients under chronic therapy with angiotensin II (AT1) receptor antagonists. J Nucl Med 2003;44 10:1574–81.

    CAS  PubMed  Google Scholar 

  20. Taa MW, Brenner BM. Combination ACEI and ARB therapy: additional benefit in renoprotection? Curr Opin Nephrol Hypertens 2002;11:377–81.

    PubMed  Google Scholar 

  21. Arnal JF, Cudek P, Plouin PF, Guyenne TT, Michel JB, Corvol P. Low angiotensinogen levels are related to the severity and liver dysfunction of congestive heart failure: implications for renin measurement. Am J Med 1991;90 1:17–22.

    CAS  PubMed  Google Scholar 

  22. Prigent A. The diagnosis of renovascular hypertension: the role of captopril renal scintigraphy and related issues. Eur J Nucl Med 1993;20 7:625–44.

    CAS  PubMed  Google Scholar 

  23. Nally JV, Barton DP. Contemporary approach to diagnosis and evaluation of renovascular hypertension. Urol Clin North Am 2001;28 4:781–91.

    CAS  PubMed  Google Scholar 

  24. Taylor A. Radionuclide renography: a personal approach. Semin Nucl Med 1999; 29 2:102–27.

    CAS  PubMed  Google Scholar 

  25. 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 Jew Hist 1991;4 698S–705S.

    CAS  Google Scholar 

  26. Holley KE, Hunt JC, Brown AL, Kincaid OW, Sheps SG. Renal artery stenosis: a clinical-pathologic study in normotensive and hypertensive patients. Am J Med 1964;37:14–22.

    CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Nuclear Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey

    Emel Ceylan Günay, Eser Lay Ergün, Bilge Volkan Salanci, Ömer Uğur & Biray Caner

  2. Sancak Mah. 252. Sokak, Ay Apt 3/4, 06550, Yıldız-Çankaya/Ankara, Turkey

    Emel Ceylan Günay

  3. Social Security Hospital Clinic of Radiology, Ankara, Turkey

    M. Halil Öztürk & Baki Hekimoğlu

  4. Department of Nephrology, Hacettepe University Faculty of Medicine, Ankara, Turkey

    Bülent Altun

  5. Department of Radiology, Hacettepe University Faculty of Medicine, Ankara, Turkey

    Barbaros Çil

Authors
  1. Emel Ceylan Günay
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  2. M. Halil Öztürk
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  3. Eser Lay Ergün
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  7. Barbaros Çil
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  8. Baki Hekimoğlu
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  9. Biray Caner
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Corresponding author

Correspondence to Emel Ceylan Günay.

Additional information

This work was presented as an abstract at the Annual Congress of the EANM, Helsinki, 2004.

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Günay, E.C., Öztürk, M.H., Ergün, E.L. et al. Losartan renography for the detection of renal artery stenosis: comparison with captopril renography and evaluation of dose and timing. Eur J Nucl Med Mol Imaging 32, 1064–1074 (2005). https://doi.org/10.1007/s00259-005-1789-9

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  • DOI: https://doi.org/10.1007/s00259-005-1789-9

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