Pre- and postcaptopril renal scintigraphy as a screening test for renovascular hypertension in children

Abstract

We studied the ability of pre- and postcaptopril renal scintigraphy to predict renovascular disease (RVD) in children. Retrospective review of medical notes and radiology reports of all hypertensive children who had had both pre- and postcaptopril renal scintigraphy with [(99m)Tc] dimercaptosuccinic acid (DMSA) and/or [(99m)Tc] mercaptoacetyltriglycine (MAG3) and digital subtraction angiography (DSA). 81 children aged 1-18 (median 10) years were studied with 62% (51) having a diagnosis of RVD. Main renal artery disease, intrarenal disease, and both main and intrarenal artery disease were present in 25, 14, and 12 patients respectively. The isotope study accurately diagnosed RVD, confirmed by DSA, in 47% (24 of 51) children, with eight false positive studies. The sensitivity, specificity, and positive and negative predictive values of the isotope study to predict RVD were 48%, 73%, 76%, and 51%, respectively. Pre- and postcaptopril renal scintigraphy was unable to predict RVD in children.

Diagnostic and medical strategy for renovascular hypertension: report from a monocentric pediatric cohort

“…A combination of MAG3 renal scintigraphy and captopril could have been prescribed in the past to determine the renovascular mechanism when the etiology of hypertension remained unclear. However, this has become unfavorable for the diagnosis of renal artery stenosis because more informative investigations are now available [1]. Moreover, because of the high frequency of bilateral lesions, renal function could be threatened by captopril usage.…”

Renal artery stenosis: is angiography still the gold standard in 2011?

“…Previous small studies have suggested that it could be useful as a screening test, but a recent large evaluation of the usefulness of this method from our institution did, however, find a sensitivity of only 47%, which thus renders this method useless [7]. The largest and best studies in adults have found sensitivity between 72 and 81%, which is also too low if a potentially curable problem is sought.…”

The role of a captopril renal scintigraphy in examination of children with hypertension: A case report

“…A number of studies, mainly referring to adult population, have shown different sensitivity and specificity of the captopril scintigraphy in the detection of renovascular disease 14 . The research results in the adult population as well as in the pediatric ones were quite inconsistent.…”