NONINVASIVE DIAGNOSIS OF RENOVASCULAR DISEASE

Objective: To present the epidemiologic and clinical features of renov ascular disease and discuss various diagnostic approaches. Design: We describe the findings in patients with fibromuscular dysplasia or athe rosclerotic disease of the renal arteries and review pertinent studies from the literature. Results: Renovascular disease is an important ca use of resistant hypertension and progressive renal insufficiency, par ticularly in the elderly population. Improved blood pressure control a nd renal function after revascularization have generated intense inter est in identifying those patients likely to benefit from this interven tion. Fibromuscular dysplasia and atherosclerotic renal artery stenosi s account for most cases of renovascular disease. Both entities produc e resistant hypertension; the latter is the more common cause of progr essive renal insufficiency-occasionally leading to end-stage renal dis ease. Angiotensin-converting enzyme inhibitor-related renal dysfunctio n, otherwise unexplained renal insufficiency, and recurrent pulmonary edema are increasingly recognized clinical manifestations of renovascu lar disease. Traditional screening tests such as intravenous pyelograp hy, intravenous digital subtraction angiography, radionuclide scintire nography, and measurement of the peripheral venous plasma renin activi ty have limited accuracy for diagnosing renal artery stenosis and do n ot accurately predict the blood pressure response to revascularization . In comparison, recently developed noninvasive tests such as captopri l renography, renal artery duplex sonography, and magnetic resonance a ngiography seem to be more accurate and, in the case of captopril reno graphy, may be more predictive of the blood pressure response to revas cularization. Conclusion: Future directions in the area of renovascula r disease should include a direct comparison among these new noninvasi ve diagnostic techniques, with a particular focus on the identificatio n of those patients most likely to benefit from revascularization in t erms of both blood pressure control and improved renal function.