0
December 16, 1992, Vol 268, No. 23 >
ARTICLE | December 16, 1992

Newer Tests for the Diagnosis of Renovascular Disease FREE

Richard A. Davidson, MD, MPH; Christopher S. Wilcox, MD, PhD
[+] Author Affiliations

Reprint requests to Box J-277, Department of Medicine, University of Florida, College of Medicine, Gainesville, FL 32610 (Dr Davidson).


JAMA. 1992;268(23):3353-3358. doi:10.1001/jama.1992.03490230083033
Text Size: A A A
Published online
Article
References

Objective.  —To evaluate published reports of diagnostic methods for renovascular hypertension, including Doppler ultrasonography, magnetic resonance imaging, the captopril test, and captopril scanning.

Data Sources.  —MEDLINE and selected references from appropriate published articles.

Study Selection.  —Studies included those that calculated sensitivities and specificities; studies that derived diagnostic criteria without application to another population of patients were excluded. Consensus of both authors was necessary for inclusion.

Data Extraction.  —Articles were critically assessed independently by the authors and a consensus critique was developed.

Data Synthesis.  —Major sources of variability exist in the investigations of recently developed tests for renovascular hypertension. These include variability in patient populations, performance of tests, and determination of outcome measures.

Conclusions.  —Among the newer diagnostic tests, both magnetic resonance imaging and Doppler ultrasonography hold promise for the anatomic detection of renal artery stenosis, but clear diagnostic criteria have not been universally accepted. There is more information concerning the captopril test, which has a sufficiently high sensitivity to be useful in the screening of high-risk patients for renovascular hypertension. Scans after captopril administration, which appear to be more specific, may enable the prediction of a blood pressure response to angioplasty or surgery.(JAMA. 1992;268:3353-3358)

REFERENCES

1 +
Simon N, Franklin S, Bleifer K, Maxwell M.  Clinical characteristics of renovascular hypertension. JAMA . 1972;;220:1209-1218.
2 +
Working Group on Renovascular Hypertension.  Detection, evaluation, and treatment of renovascular hypertension: final report. Arch Intern Med . 1987;; 147:820-829.
3 +
Sos TA, Pickering TG, Phil D, et al.  Percutaneous transluminal renal angioplasty in renovascular hypertension due to atheroma or fibromuscular dysplasia. N Engl J Med . 1983;;309:274-279.
4 +
Kirkendall WM, Fitz AE, Lawrence MS.  Renal hypertension: diagnosis and surgical management. N Engl J Med . 1967;;276:479-485.
5 +
Setaro JF, Saddler MC, Chen CC, et al.  Simplified captopril renography in diagnosis and treatment of renal artery stenosis. Hypertension . 1991;; 18:289-298.
6 +
Lewin A, Blaufox MD, Castle H, Entwisle G, Langford H.  Apparent prevalence of curable hypertension in the Hypertension Detection and Follow-up Program. Arch Intern Med . 1985;;145:424-427.
7 +
Weinberger MH.  Prevalence of secondary hypertension in the Hypertension Detection and Follow-up Program. Arch Intern Med . 1985;;145:421-422.
8 +
Ransohoff DF, Feinstein AR.  Problems of spectrum and bias in evaluating the efficacy of diagnostic tests. N Engl J Med . 1978;;299:926-930.
9 +
England WL, Grim CE, Weinberger MH, Roberts SD.  Cost effectiveness in the detection of renal artery stenosis. J Gen Intern Med . 1988;;3:344-350.
10 +
Havey RJ, Krumlovksy F, delGreco F, Martin HG.  Screening for renovascular hypertension: is renal digital-subtraction angiography the preferred noninvasive test? JAMA . 1985;;254:388-392.
11 +
Grim CE, Luft FC, Weinberger MH, Grim CM.  Sensitivity and specificity of screening tests for renal vascular hypertension. Ann Intern Med . 1979;; 91:617-622.
12 +
Thornbury JR, Stanley JC, Fryback DG.  Hypertensive urogram: a nondiscriminatory test for renovascular hypertension. Am J Radiol . 1982;;138: 43-49.
13 +
Pape JF, Gudmundsen TE, Pedersen HK.  Renal angiography may be used primarily in the diagnosis of renovascular hypertension. Scan J Urol Nephrol . 1988;;22:41-44.
14 +
Carmichael DJS, Mathias CJ, Snell ME, Peart S.  Detection and investigation of renal artery stenosis. Lancet . 1986;;1:667-670.
15 +
Hillman BJ.  Imaging advances in the diagnosis of renovascular hypertension. Am J Radiol . 1989;; 153:5-14.
16 +
Tucker TM, Strong CG, Brennan LA Jr, Sheps SG, Brown RD, Weinshiboum RM.  Renovascular hypertension: relationship of surgical curability to renin-angiotensin activity. Mayo Clin Proc . 1978;; 53:373-377.
17 +
Frederickson ED, Wilcox CS, Bucci CM, et al.  A prospective evaluation of a simplified captopril test for the detection of renovascular hypertension. Arch Intern Med . 1990;;150:569-572.
18 +
Leenen FHH, Johng W, De Wied D.  Renal venous and peripheral plasma renin activity in renal hypertension in the rat. Am J Physiol . 1973;;225:1513-1518.
19 +
Marks LS, Maxwell MH.  Renal vein renin: value and limitations in the prediction of operative results. Urol Clin North Am . 1975;;2:311-325.
20 +
Strong CG, Hunt JC, Sheps SG, Tucker RM, Bernatz PE.  Renal venous renin activity. Am J Cardiol . 1971;;27:602-611.
21 +
Sellars L, Shore AC, Wilkinson R.  Renal vein renin studies in renovascular hypertension: do they really help? J Hypertens . 1985;;3:177-181.
22 +
Luscher TF, Vetter H, Studer A, et al.  Renal venous renin activity in various forms of curable renal hypertension. Clin Nephrol . 1981;;15:314-320.
23 +
Stockigt JR, Collins RD, Noakes CA, Schambelan M, Biglieri EG.  Renal-vein renin in various forms of renal hypertension. Lancet . 1972;;1:1194-1198.
24 +
Vetter W, Vetter H, Tenschert W, et al.  Renovascular hypertension: prognostic value of renal venous renin determinations. Klin Wochenschr . 1979;; 57:863-873.
25 +
Tomoda F, Takata M, Ohashi S, et al.  Captopril-stimulated renal vein renin in hypertensive patients with or without renal artery stenosis. Am J Hypertens . 1990;;3:918-926.
26 +
Tunny TJ, Klemm SA, Hamlet SM, Gordon RD.  Diagnosis of unilateral renovascular hypertension: comparative effect of intravenous enalaprilat and oral captopril. J Urol . 1988;;140:713-715.
27 +
Thibonnier M, Joseph A, Sassano P, et al.  Improved diagnosis of unilateral renal artery lesions after captopril administration. JAMA . 1984;;251:56-60.
28 +
Re R, Novelline R, Escourrou M-T, Athanasoulis C, Burton J, Haber E.  Inhibition of angiotensin-converting enzyme for diagnosis of renal-artery stenosis. N Engl J Med . 1978;;298:582-586.
29 +
Roubidoux MA, Dunnick NR, Klotman PE, et al.  Renal vein renins: inability to predict response to revascularization in patients with hypertension. Radiology . 1991;;178:819-822.
30 +
Osborne WR Jr, Goldstone J, Hillman BJ, Ovitt TW, Malone JM, Nudelman S.  Digital video subtraction angiography: screening technique for renovascular hypertension. Surgery . 1981;;90:932-939.
31 +
Svetkey LP, Himmelstein SI, Dunnick NR, et al.  Prospective analysis of strategies for diagnosing renovascular hypertension. Hypertension . 1989;;14: 247-257.
32 +
Pohl MA, Novick AC.  Natural history of atherosclerotic and fibrous renal artery disease: clinical implications. Am J Kidney Dis . 1985;;4:A120-A130.
33 +
Handa N, Fukanaga R, Ogawa S, Matsumoto M, Kimura K, Kamada T.  A new accurate and noninvasive screening method for renovascular hypertension: the renal Doppler technique. J Hypertens . 1988;;6( (suppl 4) ):S458-S460.
34 +
Avasthi PS, Voyles WF, Greene ER.  Noninvasive diagnosis of renal artery stenosis by echo-Doppler velocimetry. Kidney Int . 1984;;25:824-829.
35 +
Taylor DC, Kettler MD, Moneta GL, et al.  Duplex ultrasound scanning in the diagnosis of renal artery stenosis: a prospective evaluation. J Vase Surg . 1988;;7:363-369.
36 +
Robertson R, Murphy A, Dubbins PA.  Renal artery stenosis: the use of duplex ultrasound as a screening technique. Br J Radiol . 1988;;61:196-201.
37 +
Hawkins PG, McKnoulty LM, Gordon RD, Klemm SA, Tunny TJ.  Non-invasive renal artery duplex ultrasound and computerized nuclear renography to screen for and follow progress in renal artery stenosis. J Hypertens . 1989;;7( (suppl 6) ):S184-S185.
38 +
Zoller WG, Hermans H, Bogner JR, Hahn D, Middeke M.  Duplex sonography in the diagnosis of renovascular hypertension. Klin Wochenschr . 1990;; 68:830-834.
39 +
Kletter K, Mostbeck G, Duczak R.  Captopril renography and duplex sonography: comparison of two noninvasive methods for the diagnosis and follow-up in renovascular hypertension. Contrib Nephrol . 1990;;79:190-195.
40 +
Dumoulin CL, Yucel EK, Vock P, et al.  Two- and three-dimensional phase contrast MR angiography of the abdomen. J Comput Assist Tomogr . 1990;;14: 779-784.
41 +
Edelman R, Wentz KU, Mattle H, et al.  Projection arteriography and venography: initial clinical results with MR. Radiology . 1989;;172:351-357.
42 +
Kent KC, Edelman R, Kim D, Steinman TI, Porter DH, Skillman JJ.  Magnetic resonance imaging: a reliable test for the evaluation of proximal atherosclerotic renal arterial stenosis. J Vase Surg . 1991;; 13:311-318.
43 +
Kim D, Edelman RR, Kent KC, Porter DH, Skillman JJ.  Abdominal aorta and renal artery stenosis: evaluation with MR angiography. Radiology . 1990;;174:727-731.
44 +
Case DB, Laragh JH.  Reactive hyperreninemia in renovascular hypertension after angiotensin blockade with saralasin or converting enzyme inhibitor. Ann Intern Med . 1979;;91:153-160.
45 +
Muller FB, Sealey JE, Case DB, et al.  The captopril test for identifying renovascular disease in hypertensive patients. Am J Med . 1986;;80:633-644.
46 +
Derkx FHM, Tan-Tjiong HL, Wenting GJ, Man in 'Veld AJ, van Seyen AJ, Schalekamp M.  Captopril test for the diagnosis of renal artery stenosis.  In: Glorioso N, Laragh JH, Rapelli A, eds. Renovascular Hypertension . New York, NY: Raven Press; 1987;:295-305.
47 +
Idrissi A, Fournier A, Renaud H, et al.  The captopril challenge test as a screening test for renovascular hypertension. Kidney Int . 1988;;34( (suppl 25) ):S138-S141.
48 +
Gosse P, Dupas JY, Reynaud P, Jullien E, Dallocchio M.  Captopril test in the detection of renovascular hypertension in a population with low prevalence of the disease. Am J Hypertens . 1989;;2:191-193.
49 +
Hansen PB, Garsdal P, Fruergaard P.  The captopril test for identification of renovascular hypertension: value and immediate adverse effects. J Intern Med . 1990;;228:159-163.
50 +
Postma CT, van der Steen PH, Hoefnagels WH, de Boo T, Thien T.  The captopril test in the detection of renovascular disease in hypertensive patients. Arch Intern Med . 1990;;150:625-628.
51 +
Postma CT, van Oijen AH, Barentsz JO, et al.  The value of tests predicting renovascular hypertension in patients with renal artery stenosis treated by angioplasty. Arch Intern Med . 1991;;151:1531-1535.
52 +
McCarthy JE, Weder AB.  The captopril test and renovascular hypertension: a cautionary tale. Arch Intern Med . 1990;;150:493-495.
53 +
Gaul MK, Linn WD, Mulrow CD.  Captopril-stimulated renin secretion in the diagnosis of renovascular hypertension. Am J Hypertens . 1989;;3:335-340.
54 +
Vaughan ED Jr, Case DB, Pickering TG, Sosa RE, Sos TA, Laragh JH.  Clinical evaluation of renovascular hypertension and therapeutic decisions. Urol Clin North Am . 1984;;11:393-407.
55 +
Ploth DW.  Angiotensin-dependent mechanisms in two-kidney, one-clip renovascular hypertension. Am J Physiol . 1983;;245:F131-F141.
56 +
Wilcox CS, Smith TB, Frederickson ED, Wingo DC, Phillips MI, Williams CM.  The captopril glomerular filtration rate renogram in renovascular hypertension. Clin Nucl Med . 1989;;14:1-7.
57 +
Erbsloh-Moller B, Dumas A, Roth D, et al.  Furosemide-131 I-hippuran renography after angiotensin-converting enzyme inhibition for the diagnosis of renovascular hypertension. Am J Med . 1991;;90:23-29.
58 +
Davidson RA, Wilcox CS.  Diagnostic usefulness of renal scanning after angiotensin converting enzyme inhibitors. Hypertension . 1991;;18:299-303.
59 +
Mann SJ, Pickering TG, Sos TA, et al.  Captopril renography in the diagnosis of renal artery stenosis: accuracy and limitations. Am J Med . 1991;;90:30-40.
60 +
Sfakianakis GN, Sfakianaki E, Bourgoignie J.  Lasix captopril renography in the diagnosis of renovascular hypertension. Contrib Nephrol . 1990;;79: 219-227.
61 +
Nally JV.  Renal scintigraphy in the evaluation of renovascular hypertension: a note of optimism yet caution. J Nucl Med . 1987;;28:1501-1505.
62 +
Dondi M, Monetti N, Fanti S, et al.  Use of Technetium-99m-MAG3 for renal scintigraphy after angiotensin-converting enzyme inhibition. J Nucl Med . 1991;;32:424-428.
63 +
Wilcox CS, Williams CM, Smith TB, Frederickson ED, Wingo CS, Bucci CM.  Diagnostic uses of angiotensin-converting enzyme inhibitors in renovascular hypertension. Am J Hypertens . 1988;;1:344S-349S.
64 +
Fine EJ.  Captopril scintirenography: a protocol to assess efficacy and methodology. Contrib Nephrol . 1990;;79:211-218.
65 +
Fommei E, Mezzasalma L, Ghione S.  Captopril radionuclide test in renovascular hypertension. Contrib Nephrol . 1990;;79:205-210.

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Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
Simon N, Franklin S, Bleifer K, Maxwell M.  Clinical characteristics of renovascular hypertension. JAMA . 1972;;220:1209-1218.
2 +
Working Group on Renovascular Hypertension.  Detection, evaluation, and treatment of renovascular hypertension: final report. Arch Intern Med . 1987;; 147:820-829.
3 +
Sos TA, Pickering TG, Phil D, et al.  Percutaneous transluminal renal angioplasty in renovascular hypertension due to atheroma or fibromuscular dysplasia. N Engl J Med . 1983;;309:274-279.
4 +
Kirkendall WM, Fitz AE, Lawrence MS.  Renal hypertension: diagnosis and surgical management. N Engl J Med . 1967;;276:479-485.
5 +
Setaro JF, Saddler MC, Chen CC, et al.  Simplified captopril renography in diagnosis and treatment of renal artery stenosis. Hypertension . 1991;; 18:289-298.
6 +
Lewin A, Blaufox MD, Castle H, Entwisle G, Langford H.  Apparent prevalence of curable hypertension in the Hypertension Detection and Follow-up Program. Arch Intern Med . 1985;;145:424-427.
7 +
Weinberger MH.  Prevalence of secondary hypertension in the Hypertension Detection and Follow-up Program. Arch Intern Med . 1985;;145:421-422.
8 +
Ransohoff DF, Feinstein AR.  Problems of spectrum and bias in evaluating the efficacy of diagnostic tests. N Engl J Med . 1978;;299:926-930.
9 +
England WL, Grim CE, Weinberger MH, Roberts SD.  Cost effectiveness in the detection of renal artery stenosis. J Gen Intern Med . 1988;;3:344-350.
10 +
Havey RJ, Krumlovksy F, delGreco F, Martin HG.  Screening for renovascular hypertension: is renal digital-subtraction angiography the preferred noninvasive test? JAMA . 1985;;254:388-392.
11 +
Grim CE, Luft FC, Weinberger MH, Grim CM.  Sensitivity and specificity of screening tests for renal vascular hypertension. Ann Intern Med . 1979;; 91:617-622.
12 +
Thornbury JR, Stanley JC, Fryback DG.  Hypertensive urogram: a nondiscriminatory test for renovascular hypertension. Am J Radiol . 1982;;138: 43-49.
13 +
Pape JF, Gudmundsen TE, Pedersen HK.  Renal angiography may be used primarily in the diagnosis of renovascular hypertension. Scan J Urol Nephrol . 1988;;22:41-44.
14 +
Carmichael DJS, Mathias CJ, Snell ME, Peart S.  Detection and investigation of renal artery stenosis. Lancet . 1986;;1:667-670.
15 +
Hillman BJ.  Imaging advances in the diagnosis of renovascular hypertension. Am J Radiol . 1989;; 153:5-14.
16 +
Tucker TM, Strong CG, Brennan LA Jr, Sheps SG, Brown RD, Weinshiboum RM.  Renovascular hypertension: relationship of surgical curability to renin-angiotensin activity. Mayo Clin Proc . 1978;; 53:373-377.
17 +
Frederickson ED, Wilcox CS, Bucci CM, et al.  A prospective evaluation of a simplified captopril test for the detection of renovascular hypertension. Arch Intern Med . 1990;;150:569-572.
18 +
Leenen FHH, Johng W, De Wied D.  Renal venous and peripheral plasma renin activity in renal hypertension in the rat. Am J Physiol . 1973;;225:1513-1518.
19 +
Marks LS, Maxwell MH.  Renal vein renin: value and limitations in the prediction of operative results. Urol Clin North Am . 1975;;2:311-325.
20 +
Strong CG, Hunt JC, Sheps SG, Tucker RM, Bernatz PE.  Renal venous renin activity. Am J Cardiol . 1971;;27:602-611.
21 +
Sellars L, Shore AC, Wilkinson R.  Renal vein renin studies in renovascular hypertension: do they really help? J Hypertens . 1985;;3:177-181.
22 +
Luscher TF, Vetter H, Studer A, et al.  Renal venous renin activity in various forms of curable renal hypertension. Clin Nephrol . 1981;;15:314-320.
23 +
Stockigt JR, Collins RD, Noakes CA, Schambelan M, Biglieri EG.  Renal-vein renin in various forms of renal hypertension. Lancet . 1972;;1:1194-1198.
24 +
Vetter W, Vetter H, Tenschert W, et al.  Renovascular hypertension: prognostic value of renal venous renin determinations. Klin Wochenschr . 1979;; 57:863-873.
25 +
Tomoda F, Takata M, Ohashi S, et al.  Captopril-stimulated renal vein renin in hypertensive patients with or without renal artery stenosis. Am J Hypertens . 1990;;3:918-926.
26 +
Tunny TJ, Klemm SA, Hamlet SM, Gordon RD.  Diagnosis of unilateral renovascular hypertension: comparative effect of intravenous enalaprilat and oral captopril. J Urol . 1988;;140:713-715.
27 +
Thibonnier M, Joseph A, Sassano P, et al.  Improved diagnosis of unilateral renal artery lesions after captopril administration. JAMA . 1984;;251:56-60.
28 +
Re R, Novelline R, Escourrou M-T, Athanasoulis C, Burton J, Haber E.  Inhibition of angiotensin-converting enzyme for diagnosis of renal-artery stenosis. N Engl J Med . 1978;;298:582-586.
29 +
Roubidoux MA, Dunnick NR, Klotman PE, et al.  Renal vein renins: inability to predict response to revascularization in patients with hypertension. Radiology . 1991;;178:819-822.
30 +
Osborne WR Jr, Goldstone J, Hillman BJ, Ovitt TW, Malone JM, Nudelman S.  Digital video subtraction angiography: screening technique for renovascular hypertension. Surgery . 1981;;90:932-939.
31 +
Svetkey LP, Himmelstein SI, Dunnick NR, et al.  Prospective analysis of strategies for diagnosing renovascular hypertension. Hypertension . 1989;;14: 247-257.
32 +
Pohl MA, Novick AC.  Natural history of atherosclerotic and fibrous renal artery disease: clinical implications. Am J Kidney Dis . 1985;;4:A120-A130.
33 +
Handa N, Fukanaga R, Ogawa S, Matsumoto M, Kimura K, Kamada T.  A new accurate and noninvasive screening method for renovascular hypertension: the renal Doppler technique. J Hypertens . 1988;;6( (suppl 4) ):S458-S460.
34 +
Avasthi PS, Voyles WF, Greene ER.  Noninvasive diagnosis of renal artery stenosis by echo-Doppler velocimetry. Kidney Int . 1984;;25:824-829.
35 +
Taylor DC, Kettler MD, Moneta GL, et al.  Duplex ultrasound scanning in the diagnosis of renal artery stenosis: a prospective evaluation. J Vase Surg . 1988;;7:363-369.
36 +
Robertson R, Murphy A, Dubbins PA.  Renal artery stenosis: the use of duplex ultrasound as a screening technique. Br J Radiol . 1988;;61:196-201.
37 +
Hawkins PG, McKnoulty LM, Gordon RD, Klemm SA, Tunny TJ.  Non-invasive renal artery duplex ultrasound and computerized nuclear renography to screen for and follow progress in renal artery stenosis. J Hypertens . 1989;;7( (suppl 6) ):S184-S185.
38 +
Zoller WG, Hermans H, Bogner JR, Hahn D, Middeke M.  Duplex sonography in the diagnosis of renovascular hypertension. Klin Wochenschr . 1990;; 68:830-834.
39 +
Kletter K, Mostbeck G, Duczak R.  Captopril renography and duplex sonography: comparison of two noninvasive methods for the diagnosis and follow-up in renovascular hypertension. Contrib Nephrol . 1990;;79:190-195.
40 +
Dumoulin CL, Yucel EK, Vock P, et al.  Two- and three-dimensional phase contrast MR angiography of the abdomen. J Comput Assist Tomogr . 1990;;14: 779-784.
41 +
Edelman R, Wentz KU, Mattle H, et al.  Projection arteriography and venography: initial clinical results with MR. Radiology . 1989;;172:351-357.
42 +
Kent KC, Edelman R, Kim D, Steinman TI, Porter DH, Skillman JJ.  Magnetic resonance imaging: a reliable test for the evaluation of proximal atherosclerotic renal arterial stenosis. J Vase Surg . 1991;; 13:311-318.
43 +
Kim D, Edelman RR, Kent KC, Porter DH, Skillman JJ.  Abdominal aorta and renal artery stenosis: evaluation with MR angiography. Radiology . 1990;;174:727-731.
44 +
Case DB, Laragh JH.  Reactive hyperreninemia in renovascular hypertension after angiotensin blockade with saralasin or converting enzyme inhibitor. Ann Intern Med . 1979;;91:153-160.
45 +
Muller FB, Sealey JE, Case DB, et al.  The captopril test for identifying renovascular disease in hypertensive patients. Am J Med . 1986;;80:633-644.
46 +
Derkx FHM, Tan-Tjiong HL, Wenting GJ, Man in 'Veld AJ, van Seyen AJ, Schalekamp M.  Captopril test for the diagnosis of renal artery stenosis.  In: Glorioso N, Laragh JH, Rapelli A, eds. Renovascular Hypertension . New York, NY: Raven Press; 1987;:295-305.
47 +
Idrissi A, Fournier A, Renaud H, et al.  The captopril challenge test as a screening test for renovascular hypertension. Kidney Int . 1988;;34( (suppl 25) ):S138-S141.
48 +
Gosse P, Dupas JY, Reynaud P, Jullien E, Dallocchio M.  Captopril test in the detection of renovascular hypertension in a population with low prevalence of the disease. Am J Hypertens . 1989;;2:191-193.
49 +
Hansen PB, Garsdal P, Fruergaard P.  The captopril test for identification of renovascular hypertension: value and immediate adverse effects. J Intern Med . 1990;;228:159-163.
50 +
Postma CT, van der Steen PH, Hoefnagels WH, de Boo T, Thien T.  The captopril test in the detection of renovascular disease in hypertensive patients. Arch Intern Med . 1990;;150:625-628.
51 +
Postma CT, van Oijen AH, Barentsz JO, et al.  The value of tests predicting renovascular hypertension in patients with renal artery stenosis treated by angioplasty. Arch Intern Med . 1991;;151:1531-1535.
52 +
McCarthy JE, Weder AB.  The captopril test and renovascular hypertension: a cautionary tale. Arch Intern Med . 1990;;150:493-495.
53 +
Gaul MK, Linn WD, Mulrow CD.  Captopril-stimulated renin secretion in the diagnosis of renovascular hypertension. Am J Hypertens . 1989;;3:335-340.
54 +
Vaughan ED Jr, Case DB, Pickering TG, Sosa RE, Sos TA, Laragh JH.  Clinical evaluation of renovascular hypertension and therapeutic decisions. Urol Clin North Am . 1984;;11:393-407.
55 +
Ploth DW.  Angiotensin-dependent mechanisms in two-kidney, one-clip renovascular hypertension. Am J Physiol . 1983;;245:F131-F141.
56 +
Wilcox CS, Smith TB, Frederickson ED, Wingo DC, Phillips MI, Williams CM.  The captopril glomerular filtration rate renogram in renovascular hypertension. Clin Nucl Med . 1989;;14:1-7.
57 +
Erbsloh-Moller B, Dumas A, Roth D, et al.  Furosemide-131 I-hippuran renography after angiotensin-converting enzyme inhibition for the diagnosis of renovascular hypertension. Am J Med . 1991;;90:23-29.
58 +
Davidson RA, Wilcox CS.  Diagnostic usefulness of renal scanning after angiotensin converting enzyme inhibitors. Hypertension . 1991;;18:299-303.
59 +
Mann SJ, Pickering TG, Sos TA, et al.  Captopril renography in the diagnosis of renal artery stenosis: accuracy and limitations. Am J Med . 1991;;90:30-40.
60 +
Sfakianakis GN, Sfakianaki E, Bourgoignie J.  Lasix captopril renography in the diagnosis of renovascular hypertension. Contrib Nephrol . 1990;;79: 219-227.
61 +
Nally JV.  Renal scintigraphy in the evaluation of renovascular hypertension: a note of optimism yet caution. J Nucl Med . 1987;;28:1501-1505.
62 +
Dondi M, Monetti N, Fanti S, et al.  Use of Technetium-99m-MAG3 for renal scintigraphy after angiotensin-converting enzyme inhibition. J Nucl Med . 1991;;32:424-428.
63 +
Wilcox CS, Williams CM, Smith TB, Frederickson ED, Wingo CS, Bucci CM.  Diagnostic uses of angiotensin-converting enzyme inhibitors in renovascular hypertension. Am J Hypertens . 1988;;1:344S-349S.
64 +
Fine EJ.  Captopril scintirenography: a protocol to assess efficacy and methodology. Contrib Nephrol . 1990;;79:211-218.
65 +
Fommei E, Mezzasalma L, Ghione S.  Captopril radionuclide test in renovascular hypertension. Contrib Nephrol . 1990;;79:205-210.

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