Newer Tests for the Diagnosis of Renovascular Disease

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.