Based on renal arteriography, hypertensive patients were classified as (1) normal, (2) unilaterally significantly abnormal, and (3) borderline cases. Those who underwent surgery were classified as cured, improved, and unchanged. The results of renograms using iodohippurate sodium I 131 chlormerodrin Hg 197 renograms and renal scans were compared to rapid sequence intravenous pyelography (RSIVP). In group 1 (ten patients), there was one false-positive iodohippurate renogram and two false-positive RSIVPs. Chlormerodrin renograms and scans were normal. In group 2 (13 patients) all iodohippurate renograms and RSIVPs reflected the side of the arteriographic lesion. Of these, 12 were cured or improved surgically. Two false-negative chlormerodrin renograms and scans occurred. In group 3 (six patients), all iodohippurate renograms reflected the side of the lesion while two patients, one cured and one improved, had negative RSIVP. Chlormerodrin renogram and scan were each falsely negative once.It is difficult to know which screening test for renovascular hypertension is most useful. Both renography and rapid sequence pyelography have been favored. While pyelographic criteria suggesting a signifiicant renovascular lesion are well standardized, renographic procedures and interpretations vary widely.1,2 Furthermore, arteriographic criteria of a renal vascular lesion significantly involved in causing hypertension are by no means certain. Surgical success has remained the final arbiter of significance. However, Bookstein3 has recently described certain objective arteriographic measurements which have a high degree of correlation with the final outcome of surgery.Using such criteria and, in most cases, the surgical outcome as evidence of a significant unilateral lesion, we have studied the corresponding preoperative renograms during hydration and have applied new and uniform objective criteria of significance. Thus, it is now possible to estimate the role of the renogram and the intravenous pyelogram as screening tests in the detection of hypertension caused by unilateral renal artery disease.
Materials and MethodsClinical Material.\p=m-\Patientsundergoing hypertensive work-up were referred to the Nuclear Medicine Section where renograms and renal scans were performed under the direct supervision of one of us (V.V.) The case material was carefully selected so as to fall into three categories: completely normal arteriogram, unilateral significantly abnormal, and borderline cases. One of us (J.Q.) later read the results without knowledge of whether or not the patient was considered to have renovascular disease. Intravenous pyelograms and aortograms were interpreted in the Radiology Department. The postoperative evaluation was performed in the hypertension clinic and results were classified by the following criteria: cured\p=m-\outpatient blood pressure below 150/95 mm Hg while receiving no drugs; i mproved\p=m-\same result on diuretics alone plus a significant lowering from preoperative levels; and un-changed\p=m-\postoperative b...