Evaluation of hypertensive patients with a solitary kidney using captopril renal scintigraphy with 99Tcm-MAG3

Fanti, Stefano; Dondi, Maurizio; Corbelli, C; Zagni, P.; Bellanova, B; Franchi, Roberto; Levorato, Maurizio; Fallani, Francesco; Marengo, Marita; Fagioli, Giorgio; Monetti, Nino

doi:10.1097/00006231-199311000-00006

Cited by 7 publications

(7 citation statements)

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“…[2][3][4] In patients with a solitary kidney and renal artery stenosis, the issue of degree of renin dependency of renal function remains controversial, while on the other hand, Fanti, et al have reported that captoprilenhanced renography is useful in patients with a solitary kidney. 5) In this previous study, five of six patients with a solitary kidney and significant renal artery stenosis had positive captopril renography findings, and they supported the hypothesis of the renin dependency of blood pressure elevation in solitary kidney with stenosis. In our patient, the renography without captopril showed a normal solitary kidney pattern, and captopril administration apparently induced a reduction in glomerular filtration.…”

Section: Discussionsupporting

confidence: 61%

“…[2][3][4] This test is also considered useful for patients with a solitary kidney, although the extent to which hypertension and renal function depend on renin is still controversial. 5) We report here a patient with a congenital solitary kidney with RVHT. Her plasma renin activity (PRA) and captopril test results were normal and her hypertension was considered to be volume-dependent rather than renin-dependent.…”

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confidence: 92%

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Congenital Solitary Kidney With Renovascular Hypertension Diagnosed by Means of Captopril-enhanced Renography and Magnetic Resonance Angiography

et al. 2005

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SUMMARYA 24 year-old woman had a congenital solitary kidney with renovascular hypertension due to fibromuscular dysplasia. She had been treated as having essential hypertension until she developed preeclampsia and HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome at 28 weeks of gestation. Plasma renin activity and captopril test results did not indicate any abnormalities. However, renography revealed captoprilinduced deterioration. Magnetic resonance angiography was also useful to detect renal artery stenosis. These findings were confirmed by renal angiography. After successful percutaneous transluminal renal angioplasty, her blood pressure and the pattern of captopril renography normalized. (Int Heart J 2005; 46: 347-353) Key words: Captopril renography, Fibromuscular dysplasia, HELLP syndrome, Magnetic resonance angiography, Renovascular hypertension, Solitary kidney RENAL artery stenosis in a patient with a solitary kidney is relatively rare. As these patients are at a high risk of developing renal insufficiency, 1) accurate assessment of the renal blood supply is essential. While angiography provides the best imaging of renal arteries and remains the gold standard, it cannot evaluate renal function and is not completely risk-free. Captopril renography, which can be used to assess the response of each of the renal functions to the renin-angiotensin system, detects renovascular hypertension (RVHT) with high sensitivity and specificity. [2][3][4] This test is also considered useful for patients with a solitary kidney, although the extent to which hypertension and renal function depend on renin is still controversial. 5) We report here a patient with a congenital solitaryFrom the

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Section: Discussionsupporting

confidence: 61%

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confidence: 92%

Congenital Solitary Kidney With Renovascular Hypertension Diagnosed by Means of Captopril-enhanced Renography and Magnetic Resonance Angiography

et al. 2005

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“…15 Although it is generally believed that individuals with a solitary kidney conform to the second model, the role of renin remains controversial because numerous studies support the view that RAAS is also activated in these patients. 16,17 Patients with solitary kidneys and stenotic renal arteries are likewise at increased risk of worsened kidney function due to secondary hypertension, chronic kidney disease, and possible contrast media nephropathy, even if renal FMDaffected patients rarely develop high creatinine levels. 5,8,17 In the present case, the patient's GFR remained within normal range, whereas proteinuria was found for 1 year before admission.…”

Section: Clinical Manifestations and Possible Pathophysiologymentioning

confidence: 99%

“…16,17 Patients with solitary kidneys and stenotic renal arteries are likewise at increased risk of worsened kidney function due to secondary hypertension, chronic kidney disease, and possible contrast media nephropathy, even if renal FMDaffected patients rarely develop high creatinine levels. 5,8,17 In the present case, the patient's GFR remained within normal range, whereas proteinuria was found for 1 year before admission. At 1-month and 3-month follow-up visits, the patient's urine protein remained negative, which allowed us to eliminate several possible causes, including primary glomerular diseases, and allowed us to link its presence with hypertensive nephrosclerosis and reduced nephron mass.…”

Section: Clinical Manifestations and Possible Pathophysiologymentioning

confidence: 99%

Fibromuscular Dysplasia Affecting a Two‐Branched Renal Artery in a Patient With a Solitary Kidney: Case Presentation

Jiang

Dong

et al. 2013

Clinical Cardiology

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Fibromuscular dysplasia (FMD) is a nonatherosclerotic, noninflammatory arterial disease, commonly involving the renal arteries. Here we report a case of a 16-year-old Chinese male who was found to have severe hypertension with proteinuria for 2 years. Computed tomography showed absence of the left kidney and enlargement of the right kidney. Subsequent angiography confirmed the above findings and revealed narrowing of both the upper and lower branches of the right renal artery caused by FMD. These combined lesions are very rare, and individuals affected are at increased risk of renal dysfunction if left untreated. Treatment with percutaneous balloon angioplasty is the first choice in such a patient and usually results in optimal outcomes.

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“…Some investigators have disputed the notion that single kidney renal artery stenosis is purely volume dependent and have argued that functional testing remains worthwhile in this subset of patients. 22 The physiologic alterations produced by renal artery stenosis with and without ACE inhibition are summarized in Table 5. The exaggerated difference in GFR and ERPF between the 'clipped' and 'unclipped' kidneys following ACE inhibition forms the basis for captopril renography.…”

Section: Physiology Of Renovascular Hypertensionmentioning

confidence: 99%

Current Perspectives on the Role of Captopril Imaging in the Diagnosis of Renovascular Disease

Collins¹,

Gusberg²

2000

Perspectives in Vascular Surgery

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As the population ages, renal artery stenosis has been increasingly detected among patients with refractory hypertension and/or renal dysfunction. There is a need for a safe, simple, reliable, cost-effective method for detecting clinically significant renal artery stenoses in patients who will benefit from revascularization. The asymmetric renal response to angiotensin converting enzyme inhibition in the setting of renal artery stenosis is the basis for several diagnostic techniques that screen patients with suspected renal artery stenoses to determine functional significance. Captopril renal scintigraphy is the most widely applied, however, ACE inhibition in conjunction with ultrasound and magnetic resonance are the focus of the most recent research. This review focuses primarily on the physiologic basis, indications, techniques and utility of captopril renal scintigraphy. Newer captopril imaging methods are introduced and consideration given to practical issues such as cost and risk/benefit analysis. Keywords Captopril, renal artery, radioisotope renographyAs our population ages, renal artery stenosis has been increasingly detected among patients with refractory hypertension and/or renal dysfunction. The evaluation and management of these often high-risk, elderly atherosclerotic patients poses significant challenges: How can clinically relevant renal artery lesions be detected most safely and reliably? If the goal is to prolong life or prevent dialysis dependence, how can we predict reliably these outcomes? And, how can we best select patients for interventions, recognizing that failed interventions in this population come at significant human and financial cost (whether they fail because the intervention is inadequate or because the renal lesion was not causative)? There is clearly a need for a safe, simple, reliable, 43

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Evaluation of hypertensive patients with a solitary kidney using captopril renal scintigraphy with 99Tcm-MAG3

Cited by 7 publications

References 0 publications

Congenital Solitary Kidney With Renovascular Hypertension Diagnosed by Means of Captopril-enhanced Renography and Magnetic Resonance Angiography

Congenital Solitary Kidney With Renovascular Hypertension Diagnosed by Means of Captopril-enhanced Renography and Magnetic Resonance Angiography

Fibromuscular Dysplasia Affecting a Two‐Branched Renal Artery in a Patient With a Solitary Kidney: Case Presentation

Current Perspectives on the Role of Captopril Imaging in the Diagnosis of Renovascular Disease

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