Split Renal Function After Captopril in Unilateral Renal Artery Stenosis

Wenting, G. J.; Tan-Tjiong, H. L.; Derkx, F. H. M.; Bruyn, J. H. B. de; Veld, A. J. Man In't; Schalekamp, M. A. D. H.

doi:10.1016/s0022-5347(17)49775-8

Cited by 37 publications

(56 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…7 The increase in radioactivity over the kidney region during the second minute after intravenous injection of ["TcJDTPA was expressed as activity ratio, that is, right/(right+left) ratio. This ratio is a measure of the single kidney contribution to the total glomerular filtration rate.…”

Section: Estimations Of Renal Plasma Flow and Split Renal Functionmentioning

confidence: 99%

Intrarenal de novo production of angiotensin I in subjects with renal artery stenosis.

et al. 1990

View full text Add to dashboard Cite

To estimate the renal extraction and de novo production of angiotensin I and to assess the contribution of blood-borne renin to renal angiotensin I production, the aortic and renal venous plasma levels of renin and intact [ I] angiotensin I and endogenous angiotensin I during continuous systemic intravenous infusion of monoiodinated [I25 I]angiotensin I were measured in subjects with unilateral renal artery stenosis (n=8) who were treated with captopril (50 mg b.i.d.). Results demonstrated that 80% of angiotensin I delivered by the renal artery was extracted both by the affected and the unaffected kidney and that on both sides a major part of angiotensin I in the renal vein was derived from intrarenai de novo production. Production of plasma angiotensin I was in excess over extraction (p<0.01) on the affected side, whereas extraction was in excess over production (p<0.01) on the contralateral side. The plasma level of de novo intrarenally produced angiotensin I in the renal vein was seven times higher on the affected side than the contralateral side. This difference was by far too big to be explained by a difference in the transit time of blood between the two kidneys, by an augmented production of angiotensin I in the circulating blood passing through the affected kidney due to the higher level of venous plasma renin activity in that kidney, or by the combination of both. We conclude that intrarenai production of angiotensin I in a compartment outside the circulating blood is a major source of this peptide in the renal vein, and that in kidneys with artery stenosis in situ, synthesized renin is an important component of this source. To the extent that local angiotensin I production by Intrarenally synthesized renin is a sine qua non for a local physiological role of renin, our results support the hypothesis that renin may have such a role. (Hypertension 1990;16:555-563) A ngiotensin II (Ang II) in the kidney subserves / \ important functions in the control of renal A. \ -blood flow, glomerular filtration rate, and tubular sodium handling. It does so by acting on specific receptors located on blood vessels and mesangial and tubular cells. arterially delivered renin or in situ synthesized renin. The interactions between systemically delivered and locally produced components of the renin-angiotensin system in the kidney are not well understood. Detailed information on how much and where Ang I and Ang II are produced in the kidney would help to answer this question.In a previous study in subjects with essential hypertension, we demonstrated that the levels of radiolabeled Ang I in arterial and venous plasma during systemic intravenous infusion of purified monoiodinated [ 125

show abstract

Section: Estimations Of Renal Plasma Flow and Split Renal Functionmentioning

confidence: 99%

Intrarenal de novo production of angiotensin I in subjects with renal artery stenosis.

et al. 1990

View full text Add to dashboard Cite

show abstract

“…21 Wenting G S et al (1984) used captopril renal scintigraphy in hypertensive patients and observed that all patient with normal RA had unchanged Tc99m-DTPA uptake after captopril administraton while patient with RAS had decreased uptake. 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.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2013

View full text Add to dashboard Cite

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.

show abstract

“…12 Persistent hypertension despite ACE inhibitor treatment, may therefore argue against the presence of renal artery stenosis. On the other hand, in some patients with renal artery stenosis renal function is highly angiotensin II-dependent, 13,14 so that the occurrence of renal function impairment during ACE inhibitor treatment may help to identify these patients.…”

Section: Introductionmentioning

confidence: 99%

Resistance to antihypertensive medication as predictor of renal artery stenosis: comparison of two drug regimens

et al. 2001

View full text Add to dashboard Cite

Background: Renal artery stenosis is among the most common curable causes of hypertension. The definitive diagnosis is made by renal angiography, an invasive and costly procedure. The prevalence of renal artery stenosis is less than 1% in non-selected hypertensive patients but is higher when hypertension is resistant to drugs. Objective: To study the usefulness of standardised twodrug regimens for identifying drug-resistant hypertension as a predictor of renal artery stenosis. Design and setting: Prospective cohort study carried out in 26 hospitals in The Netherlands. Patients: Patients had been referred for analysis of possible secondary hypertension or because hypertension was difficult to treat. Patients р40 years of age were assigned to either amlodipine 10 mg or enalapril 20 mg, and patients Ͼ40 years to either amlodipine 10 mg combined with atenolol 50 mg or to enalapril 20 mg combined with hydrochlorothiazide 25 mg. Renal angiography was performed: (1) if hypertension was drug-resistant, ie if diastolic pressure remained у95 mm Hg at three visits 1-3 weeks apart or an extra drug

show abstract

Split Renal Function After Captopril in Unilateral Renal Artery Stenosis

Cited by 37 publications

References 0 publications

Intrarenal de novo production of angiotensin I in subjects with renal artery stenosis.

Intrarenal de novo production of angiotensin I in subjects with renal artery stenosis.

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

Resistance to antihypertensive medication as predictor of renal artery stenosis: comparison of two drug regimens

Contact Info

Product

Resources

About