Screening for renovascular hypertension. A which hunt.

Pauker, Stephen G.; Kopelman, Richard I.

doi:10.1161/01.hyp.14.3.258

Hypertension

1989

DOI: 10.1161/01.hyp.14.3.258

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Screening for renovascular hypertension. A which hunt.

Stephen G. Pauker

Richard I. Kopelman

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Cited by 2 publications

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“…3 Not surprisingly, there has been increasing interest in developing screening tests capable of accurately detecting the presence of RAS and also of evaluating its functional consequences in order to select patients who may actually benefit from dilation procedures. 4 In this respect, already in the early 1990s, the duplex-Doppler ultrasound examination of the renal artery has attracted attention because, apart from being non-invasive, repeatable, and of relatively low cost, it combines the ability of visualizing the RAS with that of determining the alterations in renal blood flow through the measurement of the velocimetric indices. 5,6 Yet, the initial enthusiasm toward this technique has been tempered by the technical difficulties encountered in measuring the so-called 'proximal' velocimetric indices, that is, those sampled just at the site of the arterial narrowing.…”

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confidence: 99%

New intrarenal echo-Doppler velocimetric indices for the diagnosis of renal artery stenosis

Bardelli

Veglio

Arosio

et al. 2006

Kidney International

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We aimed at comparing the positive and negative predictive values (PPV, NPV) of several intrarenal velocimetric indices for revealing the presence of renal artery stenosis (RAS) among hypertensive patients who underwent a renal angiography for the clinical suspicion of renovascular hypertension. In 106 patients (200 kidneys), the pulsatility index (PI) and resistive index (RI), the acceleration time (AT), and the mean systolic acceleration (ACC(sys)) were evaluated. In addition, the maximal systolic acceleration (ACC(max)), that is, the maximal slope of the acceleration phase, and the maximal acceleration index (AI(max)), that is, the ratio between ACC(max) and the relative peak systolic velocity, were calculated. On angiography, we found that 56 (28%) of the 200 arteries had a greater than 60% RAS. PI and RI had an NPV below 75%, whereas AT, ACC(sys), ACC(max), and AI(max) had an NPV always above 95%. However, ACC(max), and AI(max), at their best cutoff limits, had higher PPV than ACC(sys) and AT (60 and 70% vs 45 and 51%, respectively). Thus, in a cohort of patients with a high prevalence of RAS, PI and RI failed to reach an NPV adequate for a screening test. In contrast, all the acceleration indices we tested had a sufficiently high NPV but AI(max) appears superior to the others because of higher PPV. We propose the evaluation of AI(max) as an additional screening test in patients with hypertension and the clinical suspicion of RAS.

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mentioning

confidence: 99%

New intrarenal echo-Doppler velocimetric indices for the diagnosis of renal artery stenosis

Bardelli

Veglio

Arosio

et al. 2006

Kidney International

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Prevalence of renal artery stenosis in diabetes mellitus — an autopsy study

Sawicki

Kaiser

Heinemann

et al. 1991

Journal of Internal Medicine

144

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The prevalence of renal artery stenosis in diabetic patients is unknown, since no noninvasive and valid screening procedures are available. We have therefore evaluated 5194 consecutive autopsy protocols from patients who died between 1980 and 1988. In addition, all available clinical records for patients with renal artery stenosis (RAS) and a random sample were evaluated. It was found that 73% of patients with RAS were hypertensive, and 53% had diabetes, all but one being Type 2 (non-insulin-dependent). Renal artery stenosis was present in 225 (4.3%) of all patients [95% confidence interval (95% CI), 3.8-4.9], and was not reported in the patients' clinical records in 93% of cases. RAS was present in 8.3% of all diabetic patients (95% CI, 6.8-9.8%), the odds ratio being 3.5 (95% CI, 2.6-4.6). The frequency of renal artery stenosis in diabetic patients with hypertension was 10.1%. Bilateral renal artery stenosis was found in 43% of patients with RAS and diabetes, and in 30% of non-diabetic patients with RAS (P = 0.059). Our results indicate that renal artery stenosis often goes undetected before autopsy. The presence of non-insulin-dependent diabetes mellitus increases the risk of renal artery stenosis. The risk of bilateral renal artery stenosis is greater in diabetic patients. These results may be of significance with regard to the diagnostic evaluation and choice of antihypertensive treatment in hypertensive non-insulin-dependent diabetic patients.

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Screening for renovascular hypertension. A which hunt.

Cited by 2 publications

References 10 publications

New intrarenal echo-Doppler velocimetric indices for the diagnosis of renal artery stenosis

New intrarenal echo-Doppler velocimetric indices for the diagnosis of renal artery stenosis

Prevalence of renal artery stenosis in diabetes mellitus — an autopsy study

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