DEFINING THE ROLE OF RENAL ANGIOGRAPHY IN THE DIAGNOSIS OF RENAL-ARTERY DISEASE

The current goal of angiography in the diagnosis of renal artery disea se is poorly defined, probably because of the diversity of patients pr esenting for management. The current application of angiography is bet ter understood when pot into perspective with the patient population t hat we are trying to screen. There are two distinct patient population s with renovascular disease: those with uncontrolled hypertension and those with azotemia or risk of progression to end-stage renal disease. The role of angiography in these two patient populations is quite dif ferent. In patients with hypertensive renovascular disease, angiograph y should be applied rather late and should be preceded by other noninv asive testing to screen patients from those with essential hypertensio n, since the prevalence of this disease is low and the cost implicatio ns of applying angiography primarily are immense. The two promising te sts in this setting are captropril renography and duplex ultrasound sc anning. In contradistinction, patients with azotemic renovascular dise ase, suffering from bilateral renal artery stenoses, or suffering from stenosis of the renal artery in a solitary kidney may be better studi ed by early application of renal angiography, especially those at risk of progression and for whom intervention is indicated. (C) 1994 by th e National Kidney Foundation, Inc.