A REVIEW OF CAPTOPRIL RENAL SCINTIGRAPHY AND ITS EFFECT ON PATIENT-MANAGEMENT

Renal artery stenosis is an important and potentially curable cause of hypertension. Captopril renography is now recognized to have a high s ensitivity and specificity in its diagnosis. Ultimately, however, the result is of little benefit ii it does not lead to a change in patient management. To assess how patient management was changed following th e result of a captopril renogram, we reviewed the notes of 95 patients who had undergone this test over a 5 year period to identify renal ar tery stenosis. Of these patients, significant renal artery stenosis wa s suggested in 16 (17%), of whom only 9 (56%) underwent a change in ma nagement (7 proceeding to angiography with or without angioplasty, 2 h aving alterations in medication). In the 67 patients who had a negativ e renogram, 16 (24%) had an alteration in management (13 angiography, 3 altered drug treatment). Finally, of the 12 patients who had a non-d iagnostic renogram, 7 (60%) had a management change (3 angiography, 4 altered drug therapy). Our results suggest that, despite evidence from the literature that captopril renography is both sensitive and specif ic for renal artery stenosis, clinicians still rely on other factors w hen determining who has significant stenosis and, therefore, who shoul d proceed to a further investigation or have a change in medication. U ltimately, this reduces the clinical value of the test at present.