The Significance of Captopril Renography in Renovascular Hypertension

Oei, H. Y.; Geyskes, G. G.; Mees, E. J. Dorhout; Puylaert, C B

doi:10.1159/000413788

Cited by 22 publications

(7 citation statements)

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“…one hour before the administration of the tracer. Following captopril administration, criteria of suspected stenosis were: with 99m Tc-DTPA, a fall in glomerular filtration rate of the affected side >5%; with 99m Tc-MAG3, an increase of at least 0.15 of the 20 minutes/peak count ratio (ratio between the activity after 20 minutes and peak radioactivity); or a lengthening of >2 min of T max value, or a delay of tracer elimination in the pelvis of >2 minutes [13,14]. …”

Section: Methodsmentioning

confidence: 99%

Atherosclerotic ischemic renal disease. Diagnosis and prevalence in an hypertensive and/or uremic elderly population

et al. 2003

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BackgroundAtherosclerotic ischemic renal disease is a frequent cause of end-stage renal failure leading to dialysis among the elderly; Its prevalence is inferred from autopsy or retrospective arteriographic studies. This study has been conducted on 269 subjects over 50 with hypertension and/or CRF, unrelated to other known causes of renal disease.MethodsAll 269 patients were studied either by color-flow duplex sonography (n = 238) or by renal scintigraphy (n = 224), and 199 of the 269 patients were evaluated using both of these techniques. 40 patients, found to have renal artery stenosis (RAS), were subjected to 3D-contrast enhancement Magnetic Resonance Angiography (MRA) and/or Selective Angiography (SA). An additional 23 cases, negative both to scintigraphy and to ultrasound study, underwent renal angiography (MRA and/or SA).ResultsColor-duplex sonography, carried out in 238 patients, revealed 49 cases of RAS. MR or SA was carried out in 35 of these 49 patients, and confirmed the diagnosis in 33. Color-duplex sonography showed a PPV value of 94.3% and NPV of 87.0% while renal scintigraphy, carried out in 224 patients, had a PPV of 72.2% and a NPV of 29.4%. Patients with RAS showed a higher degree of renal insufficiency compared to non stenotic patients while there were no differences in proteinuria. RAS, based on color-duplex sonography studies, was present in 11% of patients in the age group 50–59, 18% in the 60–69 and 23% at age 70 and above.ConclusionsA relatively large percentage of the elderly population with renal insufficiency and/or hypertension is affected by RAS and is at risk of developing end-stage renal failure. Color-duplex ultrasonography is a valid routine method of investigation of population at risk for renal artery stenosis.

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Section: Methodsmentioning

confidence: 99%

Atherosclerotic ischemic renal disease. Diagnosis and prevalence in an hypertensive and/or uremic elderly population

et al. 2003

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“…Criteria of suspected stenosis were: a difference in split renal function 1 30%, T max 1 5 min, with a difference between kidneys 1 1 min, parenchymal transit time 1 4 min. Following captopril administration, 25 mg p.o., a fall in the GFR of the affected side 1 5%, an increase of at least 5 min of T max and an increase of 20% of the parenchymal transit time, with unaltered filtration in the contralateral kidney, were considered significant of renal artery stenosis [11,12].…”

Section: Methodsmentioning

confidence: 99%

Ischemic Nephropathy in an Elderly Nephrologic and Hypertensive Population

Coen¹,

Manni²,

Giannoni

et al. 1998

Am J Nephrol

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Background: Atherosclerotic renovascular disease is a frequent cause of end-stage renal failure leading to dialysis in the elderly population. Its prevalence is known from autopsy or retrospective arteriographic investigations. This prospective study was conducted in 133 subjects with the inclusion criteria of hypertension and/or chronic renal failure starting after 50 years of age. Renal failure was unrelated to other known causes of renal disease. Methods: The patients were subjected to echo-color doppler ultrasonography of renal arteries (104) and/or to renal scintigraphy (112). Thirteen of 27 patients with positivity using one or both noninvasive techniques were subjected to digital selective angiography. Results: All the patients with positivity of echo-color doppler technique were true positives, with a consequent predictive value reaching 100%. Renal scintigraphy was of markedly lower predictive value. Based on the echo-color doppler investigation, percentage positivity for hemodynamically significant stenosis (>50%) was 3.2 (16.3% had mild nonsignificant stenosis of renal arteries) in the 50- to 59-year-old group, 20% (plus 12.5% with nonsignificant stenosis) in the 60- to 69-year-old group and 25% (plus 17.8% nonsignificant stenosis) in the >70-year age group. Patients with significant stenosis also had a significantly higher degree of renal insufficiency and received a higher number of hypotensive drugs (p < 0.013). The percentage of hypertensive patients was not different in the stenotic and nonstenotic groups. Conclusions: A large percentage of the elderly population is affected by renal vascular obstructive disease and is at risk of developing end-stage renal failure. Considering the wide number of cases with foreseeable renal arterial stenosis in the vast population meeting the selection criteria, it is possible to conclude that not all cases evolve to renal failure due to different rates of progression or to untimely nonrenal death.

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“…Most of the papers published on this subject report positive results [6][7][8][9][10][11][12], although some other observations have been less encouraging [13]. Since the incidence of renovascular hypertension in any single centre is predictably low, a collaborative study, "The CRT European Multicentre Study on Renovascular Hypertension", was undertaken in order to collect enough data to estimate the sensitivity, specificity and diagnostic accuracy of the test [14].…”

Section: Introductionmentioning

confidence: 99%

Captopril radionuclide test in renovascular hypertension: a European multicentre study

et al. 1993

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The diagnostic work-up of renovascular hypertension is still controversial. The efficacy of renal scintigraphy with technetium-99m diethylene triamine pentaacetate (DTPA) before and after captopril (scintigraphic captopril test) was evaluated in a multicentre study. All 380 hypertensive patients in the study underwent renal arteriography; 125 had renal arterial stenosis > or = 70%, and 54 had a technically successful intervention to correct the stenosis. The post-captopril study had a sensitivity of 93% and a specificity of 100% for predicting blood pressure response to intervention, if renal function was normal and a combination of quantitative parameters was applied (individual kidney uptake index < 40%, time to peak activity < 2 min or > 10 min). In the entire population renal artery stenosis > or = 70% was detected with a sensitivity of 83% and a specificity of 93% if renal function was normal. In patients with abnormal renal function the performance of the test was worse, owing to a lower specificity which could be increased by using only time parameters. The performance of the test was optimal when the post-captopril findings were examined; no improvement was achieved by evaluation of the changes induced by captopril from the baseline. The test can thus be simplified by performing only a post-captopril study for routine use: a negative test would exclude a curable form of renovascular hypertension in > 80% and a positive test would predict it in > 90% of the patients selected for suspicion of the disease.(ABSTRACT TRUNCATED AT 250 WORDS)

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The Significance of Captopril Renography in Renovascular Hypertension

Cited by 22 publications

References 0 publications

Atherosclerotic ischemic renal disease. Diagnosis and prevalence in an hypertensive and/or uremic elderly population

Atherosclerotic ischemic renal disease. Diagnosis and prevalence in an hypertensive and/or uremic elderly population

Ischemic Nephropathy in an Elderly Nephrologic and Hypertensive Population

Captopril radionuclide test in renovascular hypertension: a European multicentre study

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