Effects of converting enzyme inhibition on split renal function in renovascular hypertension.

Miyamori, Isamu; Yasuhara, Shuichiro; Takeda, Yoshiyu; Koshida, Hideo; Ikeda, Masatoshi; Nagai, Kojiro; Okamoto, Haruo; Morise, Toshio; Takeda, R; Aburano, Tamio

doi:10.1161/01.hyp.8.5.415

Cited by 56 publications

(15 citation statements)

References 17 publications

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“…Our data confirm small reports that postcaptopril differential GFR renography detects renal artery stenosis with 92% sensitivity. 10 ' 24 But our data do not confirm previously reported specificities of 74-90%. 10 -24 Our data suggest that this test has a substantially higher false-positive rate (1 -specificity) than captoprilstimulated peripheral renin activity.…”

Section: Discussioncontrasting

confidence: 99%

Prospective analysis of strategies for diagnosing renovascular hypertension.

et al. 1989

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Renovascular hypertension is a potentially curable form of high blood pressure. However, it is unclear how best to select patients who are likely to have renovascular hypertension, what diagnostic strategy to use in these selected patients, and how to predict the hemodynamic significance of a renal artery stenosis. We determined the prevalence of renovascular hypertension in adults who exhibited suggestive clinical features. In these clinically selected patients, we then determined the test characteristics of various diagnostic and potential screening tests. Renovascular hypertension was diagnosed if correction of renal artery stenosis resulted in decreased blood pressure. Of the 66 hypertensive adults evaluated, 11 (16.7%) had renovascular hypertension. Captopril-stimulated peripheral renln activity detected renovascular hypertension with 73% sensitivity, 72% specificity, 38% positive predictive value, and 92% negative predictive value. Less optimal combinations of sensitivity and specificity were found for differential glomerular filtration rate renography, differential effective renal plasma flow renography, and selective renal vein renin ratios, each performed after a single dose of captopril. Intravenous digital subtraction renal angktgraphy detected all patients with renovascular hypertension and was normal in 71% of patients with essential hypertension. To evaluate potential screening tests for renovascular hypertension, we calculated predictive values applied to a low prevalence population. If the observed sensitivities and specificities apply to a population with 5% prevalence of renovascular hypertension, captopril-stimulated peripheral renin would have a positive predictive value of 12% and a negative predictive value of 98%. In 16 patients with known renal artery stenosis, neither the captopril-stimulated renal vein renin ratio nor captopril-stimulated differential renography accurately predicted blood pressure response to correction of the stenosis. We conclude that clinical criteria can identify a subgroup with 16.7% prevalence of renovascular hypertension. In this high prevalence group, intravenous digital subtraction renal angiography will identify virtually all patients with renovascular hypertension, and a normal study will be sufficient to exclude renovascular hypertension. In unselected hypertensive patients, screening with captopril-stimulated peripheral renin activity may be the most useful and efficient procedure for identification of patients with renovascular hypertension. Functional tests do not accurately predict the hemodynamic significance of a renal artery stenosis. {Hypertension 1989;14:247-257) R enovascular hypertension (RVH) is a potentially curable form of high blood pressure. Its treatment, with angioplasty or surgery, provides the opportunity to prevent cardiovascular morbidity and mortality due to hypertension and to avoid the expense and potential morbidity of lifelong pharmacotherapy for hypertension. Therefore, this condition should be identified and treated whenever poss...

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Section: Discussioncontrasting

confidence: 99%

Prospective analysis of strategies for diagnosing renovascular hypertension.

et al. 1989

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“…The growing interest in this potentially diagnostic technique is apparent from the increasing number of papers reporting both clinical and experimental observations on this subject. 7 " 10 In two preliminary accounts"' 12 we also reported similar results. The present report details our comparison of 14 patients with abnormal postcaptopril DTPA renal scintigrams with a group of patients with normal scintigrams.…”

supporting

confidence: 65%

“…The dissociation in the kidney ipsilateral to the stenosis between the effect of captopril on renal blood flow (which was maintained) and that on GFR (which was suppressed) recently has been demonstrated by our group in one renovascular patient by comparing ""Tc-DTPA renal scintigraphy and scintigraphic images of the kidneys after injection of labeled microspheres during arteriog- raphy." The recent report of Miyamori et al, 7 of a selective decrease of GFR in the stenosed kidney despite an increase of plasma flow after 1 to 48 weeks of captopril treatment, adds further support to the idea that ACE inhibition induces an impairment of GFR autoregulation in the affected kidney.…”

Section: Discussionmentioning

confidence: 77%

Renal scintigraphic captopril test in the diagnosis of renovascular hypertension.

Fommei¹,

Ghione²,

Palla³

et al. 1987

Hypertension

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SUMMARY Angiotensin converting enzyme (ACE) inhibitor-induced renal failure has been reported in bilateral renal artery stenosis and in stenosis in solitary kidneys, but not in unilateral renal artery stenosis. In these patients, however, a functional impairment of the kidney ipsilateral to the stenosis can often be detected after ACE inhibition by scintigraphic techniques employing glomerular radionuclide tracers like 99n> Tc-diethylenetriamine pentaacetic acid (DTPA). Dynamic renal scintigraphy with "Tc-DTPA before and 1 hour after administration of captopril, 25 mg (renal scintigraphic captopril test; RSCT), was performed in a selected series of 39 hypertensive subjects with suspected renovascular hypertension. Changes in glomerular filtration rate induced by captopril on the individual kidney were estimated by assessing the early (120-180 seconds) DTPA uptake by the kidney. Values were expressed as the ratio between the kidney with the lower uptake and the contralateral one in 34 patients and as the ratio of the kidney counts to the injected dose in five patients with solitary kidneys, aortic coarctation, or both. Compared with precaptopril values, postcaptopril uptake decreased markedly in 14 subjects ( -62.42 ± 30.94 [SD]%; range, -25 to -100%) and decreased modestly or even increased in the other 25 ( + 0.57 ± 9.83%; range, + 28 to -13%). Of the 14 subjects considered to be RSCT-positive diagnostic workup revealed either established (10) or strongly suspected (2) renal artery stenosis in 12 and aortic coarctation in 2 subjects. In another patient with established renovascular hypertension, results of the RSCT were negative when performed in the supine position but became positive when repeated in the sitting position. Nine patients underwent repair of stenosis by either operation or angioplasty, and a striking correspondence was observed between response to RSCT and success of intervention. Taken together these findings strongly suggest that renal scintigraphy after ACE inhibition represents a promising tool for diagnosis of renovascular hypertension and its follow-up after operation or angioplasty. (Hypertension 10: 212-220, 1987) KEY WORDS • renovascular hypertension renal scintigraphy angiotensin converting enzyme inhibition

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“…22 Miyamori I et al (1986) using post captopril Tc99m-DTPA showed that reduction in GFR following captopril in stenotic artery was due to reduction of angiotensin-II mediated efferent arteriolar constriction. 23 Sfakianakis NG et al (1987) compared 131 I-iodohippurate (OIH) and Tc99m-DTPA Scintigraphy in same patient and showed that scintigraphy with OIH scintigraphy with OIH appears to be more sensitive and specific than DTPA and concluded that OIH scintigraphy with captopril may provide a rapid and sensitive screening test for RVH. 24 Fommei E at al (1987) reported positive captopril induced changes in Tc99m-DTPA scintigraphy which predicted patients who can be cured by revascularization or percutaneous transfemoral renal angioplasty (PTRA).…”

Section: Discussionmentioning

confidence: 99%

Captopril Renal Scintigraphy in Screening and Diagnosis of Renal Artery Stenosis - A Prospective Study

et al. 2013

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The present study was carried out to assess the role of Tc99m-DTPA captopril renal scintigraphy in screening and diagnosing of patients with renal artery stenosis. Materials and Methods: A total of 26 hypertensive patients with a clinical suspicion of RAS underwent baseline and captopril scintigraphy using 259-370 MBq (7-10mCi) of Tc99m-DTPA. The captopril scintigraphy was done after oral dose of 50mg of captopril with in three baseline study. DSA was done in all patients irrespective of scintigraphy results due to high clinical suspicion of RAS. Results: Of 26 patients, 18 had renal artery stenosis (10 unilateral, 8 bilateral), making a total of 26 involved RA on DSA. Of these 26 involved RA, 16 were stenosis> 60%, 2 were stenosed< 60% while 8 were completely occluded. Of the sixteen RA with stenosis > 60%, only 12 were detected by captopril scintigraphy (Sensitivity-75%). Eight kidneys with complete occlusion, 6 were non-functioning and 2 were poorly functioning (<20%) on scintigraphy. Among 27 normal RA, (25 normal and two <60% stenosis) only 19 were negative on scintigraphy (specificity-70%). Two kidneys with less than 60% stenosis were positive on scintigraphy. The overall accuracy of captopril DTPA scintiography was found to be 72.1% with PPV and NVP of 66.7% and 82.6% respectively. Two patients with accessory RA were not picked up on captopril scintigraphy. Conclusion: Tc99m-DTPA captopril scintigraphy has average sensitivity and specificity. The effectiveness of captopril scintigraphy in diagnosis of completely occuluded RA, accessory RAS and RAS in poorly functioning kidney is poor, therefore this test can not be considered as screening test for RVH.

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Effects of converting enzyme inhibition on split renal function in renovascular hypertension.

Cited by 56 publications

References 17 publications

Prospective analysis of strategies for diagnosing renovascular hypertension.

Prospective analysis of strategies for diagnosing renovascular hypertension.

Renal scintigraphic captopril test in the diagnosis of renovascular hypertension.

Captopril Renal Scintigraphy in Screening and Diagnosis of Renal Artery Stenosis - A Prospective Study

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