Nieto J, Alcazar R, Alonso JC, Ferreras I, Caparros G, de la
Torre M, Martin R, et al
Aspirin radionuclide test in renovascular hypertension
Am Soc Nephrol
J Am Soc Nephrol (abstract)
(Sep) 7:1553 1996
Glomerular capillary pressure in renovascular hypertension is
maintained by dilatation of the pre-glomerular vasculature distal to
the obstruction (due to enhanced vasodilatory prostaglandins) and
constriction of the efferent arterioles (due to angiotensin II).
Using scintigraphic techniques, the effects of aspirin (20 mg/kg)
and captopril (50 mg) in RVH were assessed. 17/24 patients with
suspected RVH had abnormal renograms (10 with aspirin, 1 with
captopril, and 6 with both). Unilateral stenosis was better
predicted with aspirin- than with captopril-renography. Thus
inhibition of prostaglandins which decreases both renal plasma flow
and GFR may be a better test for RVH than captopril renography.
Comment: This is a provocative study. Unfortunately, insufficient
data are provided in the abstract. In a previous publication
(Imanishi et al. Kidney Int 1994; 45: 1170-6), in which the same
doses of the two agents were compared in 7 patients, aspirin
scintography was found to be a more sensitive test; however, both
agents detected severe stenosis (> 75%). We await further
information.
(David J. Leehey, M.D., Loyola University at Chicago)
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Am Soc Nephrol
H: Special problems :
Renovascular hypertension