Captopril renography in the diagnosis of renal artery stenosis: accuracy and limitations

Mann, Samuel J.; Pickering, Thomas G.; Sos, Thomas A.; Uzzo, Robert G.; Sarkar, Salil D.; Friend, K. D.; Rackson, Marlene; Laragh, John H.

doi:10.1016/0002-9343(91)90503-p

Cited by 142 publications

(69 citation statements)

References 31 publications

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“…Although peripheral renin activity is usually elevated in patients with renovascular hypertension, approximately 20% of patients with renovascular hypertension have normal plasma renin activity, while up to 16% of patients with essential hypertension may have elevated plasma renin activity. 5,6) Therefore, the measurement of peripheral renin activity has been shown to be inadequate for the diagnosis of renovascular hypertension. Case and Laragh 7) were the first to show that the reactive rise in renin following administration of captopril is greater in patients with renovascular hypertension than in those with essential hypertension.…”

Section: Discussionmentioning

confidence: 99%

Reversible Renin-dependent Renovascular Hypertension Successfully Treated With Percutaneous Transluminal Renal Angioplasty and Stenting

Fang

Lin

2005

Int. Heart J.

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SUMMARYA 37-year old woman was suspected of having renovascular hypertension because of recent onset severe hypertension (blood pressure 220/135 mmHg; compared to 132/65 mmHg two years earlier) and an abdominal bruit. A captopril renal scan indicated the presence of right renal artery stenosis. Additionally, a captopril plasma renin activity (PRA) provocation test showed a positive result for renovascular hypertension (baseline PRA = 291 µU/mL; 1 hour post-captopril PRA = 1444 µU/mL). Selective renal angiography demonstrated a severe critical stenotic lesion at the distal portion of the right renal artery. Blood pressure (BP) decreased to 136/80 mmHg one day after successful percutaneous transluminal renal angioplasty and stenting. Repeat renal angiography six months after the procedure revealed no evidence of in-stent restenosis. Blood pressure (BP = 137/ 76 mmHg) and plasma renin profile (baseline PRA = 23.8 µU/mL; 1 hour post-captopril PRA=22.3 µu/mL) also were normal six months following initial revascularization. Moreover, blood pressure (137/84 mmHg) and renin profile remained normal 2.5 years after the procedure (baseline PRA = 24.3 µU/mL; 1 hour post-captopril = 25.6 µU/mL). The results of this study have thus demonstrated a case of renin-dependent renovascular hypertension in which both the blood pressure and plasma renin activity profile normalized following successful percutaneous transluminal angioplasty and stenting. (Int Heart J 2005; 46: 339-345)

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Section: Discussionmentioning

confidence: 99%

Reversible Renin-dependent Renovascular Hypertension Successfully Treated With Percutaneous Transluminal Renal Angioplasty and Stenting

Fang

Lin

2005

Int. Heart J.

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“…Because renovascular hypertension can be treated successfully in a large number of patients, it is worthwhile to try to identify those with this condition among the general hypertensive population [22][23][24][25]. However, the certain diagnosis of a renal artery stenosis can only be made by an-giography [22][23][24][25].…”

Section: Discussionmentioning

confidence: 99%

“…However, the certain diagnosis of a renal artery stenosis can only be made by an-giography [22][23][24][25]. In view of the low prevalence of renal artery stenosis in the hypertensive population, angiography, because of its invasive nature and cost, cannot be used as a screening procedure.…”

Section: Discussionmentioning

confidence: 99%

Urinary prostaglandin and prostaglandin metabolite excretion in patients with essential hypertension or hypertension with renal artery stenosis

Postma

Boo²,

Thomas

et al. 1995

The Netherlands Journal of Medicine

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Background: Recent studies have reported elevated prostaglandin levels in patients with renal artery stenosis and hypertension. To investigate whether a distinction between essential hypertension and hypertension with renal artery stenosis is possible by measuring eicosanoid excretion, we studied the excretion of these compounds in patients with essential hypertension and in hypertensives with concomitant renal artery stenosis.Methods: The 24-h urinary excretion of metabolites of prostaglandin I2, prostaglandin E 2 and metabolites of thromboxane A 2 was sampled under standardised conditions, in 15 patients with essential hypertension and in 15 patients with unilateral renal artery stenosis with hypertension. Also clinical and biochemical characteristics of the subjects were analysed.Results: The patients with renal artery stenosis had significantly lower excretion of prostaglandin I 2 than did the essential hypertensive patients. However, the overlap in the values was large, thus not allowing a diagnostic differentiation according to urinary prostaglandin I z levels. The excretion of prostaglandin E 2 and of metabolites of thromboxane A 2 showed no significant differences among the groups.Conclusions: Measurement of urinary prostaglandin or prostaglandin metabolite excretion did not contribute to the non-invasive detection of the presence of a renal artery stenosis in the patients in this study.

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“…27 The role of duplex scanning and captopril renography has extensively been discussed in previous publications. 3,10,30,31 …”

Section: Competing Testsmentioning

confidence: 99%

Captopril test: time over?

et al. 1999

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Objective: The role of non-invasive tests for the detection of renovascular hypertension is still a matter of controversy. The 'captopril test' is widely used; its clinical usefulness, however, remains questionable. The aim of the current study was therefore to report our own experience and to review the published data on the diagnostic significance of the test. Patients and methods: Data from 485 hypertensive patients who underwent a captopril test in consecutive order at our institution were analysed retrospectively. After a 30-min resting period in the supine position 50 mg of captopril was given orally. Blood was collected before and 90 min after dosage for the determination of plasma renin concentration (normal range 3.5-8.0 ng/ml/h). An increase by 100% or more of the baseline value was considered a positive response. Blood pressure was recorded at baseline and at 90 min.

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Captopril renography in the diagnosis of renal artery stenosis: accuracy and limitations

Cited by 142 publications

References 31 publications

Reversible Renin-dependent Renovascular Hypertension Successfully Treated With Percutaneous Transluminal Renal Angioplasty and Stenting

Reversible Renin-dependent Renovascular Hypertension Successfully Treated With Percutaneous Transluminal Renal Angioplasty and Stenting

Urinary prostaglandin and prostaglandin metabolite excretion in patients with essential hypertension or hypertension with renal artery stenosis

Captopril test: time over?

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