ADVANCES IN NONINVASIVE SCREENING FOR RENOVASCULAR DISEASE

The presence of clinical clues increases the predictive value of scree ning tests for renovascular hypertension; these include abrupt onset o f hypertension before age 30 or after age 55, severe hypertension, acc elerated or malignant hypertension, hypertension refractory to a tripl e-drug regimen, moderate hypertension with diffuse vascular disease, a n epigastric bruit, moderate hypertension with unexplained azotemia, a nd azotemia induced by an angiotensin-converting enzyme inhibitor. Cap topril renography and duplex ultrasonography are clinically useful scr eening tools, but wide variation in accuracy exists among institutions . Magnetic resonance angiography may emerge as an effective clinical t est.