The place of renal scintigraphy in the diagnosis of renal artery stenosis. Fifteen years of clinical experience

Abstract

The diagnostic accuracy of renal scintigraphy has not been improved by the introduction of mertiatide or by the use of captopril. The usefulness of scintigraphy as a diagnostic test for the presence of renal artery stenosis remains questionable. The physician will always confront either a substantial number of arteriograms that do not show abnormalities when renal scintigraphy is omitted as a screening step or a substantial number of missed diagnoses when a renal scan that shows abnormalities is used as a prerequisite for arteriography.

ACC/AHA 2005 Practice Guidelines for the Management of Patients With Peripheral Arterial Disease (Lower Extremity, Renal, Mesenteric, and Abdominal Aortic)

“…The accuracy of captopril renography in identifying patients with renovascular disease has been variable, with reported sensitivities of approximately 85% (range 45% to 94%) and specificities of approximately 93% (range 81% to 100%) (674)(675)(676)(677)(678)(679)(680)(681)(682)(683)(684)(685).…”

Increased Renal Arterial Resistance Predicts the Course of Renal Function in Type 2 Diabetes With Microalbuminuria

“…Although captopril renography was once the noninvasive diagnostic method of choice for patients with renal stenosis, it has now been relegated to use in secondary screening, because the quality of other noninvasive imaging methods is highly reliable and less cumbersome (12,13). It has recently been found that a renal arterial resistance index (R/I) of Ն80, using Doppler ultrasound technique, predicts worsening renal function in patients with renal diseases other than renal artery stenosis (14,15).…”

Diagnostic imaging of renal artery stenosis

“…36 Typically 25-50 mg of oral captopril is used. [38][39][40] Profound hypotension may follow the first dose of ACE inhibitor and therefore the blood pressure is monitored regularly and any hypotensive episodes treated appropriately.…”

“…37,38,41 Some authors rely on post ACE inhibition renograms only 40 and others feel that overall diagnostic accuracy has not been improved since the addition of ACE inhibitors. 39 The usefulness of renal scintigraphy as a diagnostic test for renal artery stenosis has recently been questioned. 39 Its negative predictive value is 72% and in one series a third of patients with proven renovascular hypertension had negative ACE inhibition scintigraphy.…”

“…39 The usefulness of renal scintigraphy as a diagnostic test for renal artery stenosis has recently been questioned. 39 Its negative predictive value is 72% and in one series a third of patients with proven renovascular hypertension had negative ACE inhibition scintigraphy. 42 The use of post-captopril renal scintigraphy for the prediction of response to intervention in RAS has shown more consistent results.…”