RENOVASCULAR HYPERTENSION

The accuracy of various noninvasive screening tests for the detection of renal artery stenosis (urography, duplex scanning, radionuclide sci ntirenography, intravenous digital subtraction angiography, spiral CT and MR angiography) is discussed. All these methods may show false-neg ative and false-positive results. Therefore, in the case of a high ind ex of clinical suspicion (i.e. refractory hypertension, recent elevati on of serum creatinine, renal dysfunction, asymmetry of kidney size) r enal arteriography must be performed. Since the natural history of ath erosclerotic and fibrous renal artery stenosis is characterized by pro gression of the disease with loss of renal function despite good blood pressure control, surgical revascularization or percutaneous angiopla sty should be performed whenever possible.