Hansson J, Dey H, Concato J, Huot S
Accuracy of captopril renal scans in clinical practice: impact
of spectrum bias
Am Soc Nephrol
J Am Soc Nephrol (abstract)
(Sep) 7:1550 1996
Captopril renography has been resported to be highly sensitive and
specific for the diagnosis of renal artery stenosis (RAS). The
charts of 55 patients who underwent CRS and angiography over a 5-yr
period were reviewed. The sensitivity and specificity of CRS were
75% and 55% and the prevalence of RAS 40%. In patients without
vascular disease, the positive predictive value of CRS was only
22%. The authors conclude that CRS is poorly predictive of RAS in
patients with refractory hypertension but no evidence of vascular
disease.
Comment: These data are not really surprising since it is well
known that RAS is much more likely to be present in hypertensive
patients with clinically-evident vascular disease. These data
should not discourage the use of CRS, since it has been shown by
several groups that positive CRS is highly predictive of an
antihypertensive response to renal revascularization.
(David J. Leehey, M.D., Loyola University at Chicago)
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Am Soc Nephrol
H: Special problems :
Renovascular hypertension