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Special Communication
July 19, 1985

Screening for Renovascular Hypertension: Is Renal Digital-Subtraction Angiography the Preferred Noninvasive Test?

Author Affiliations

From the Sections of General Internal Medicine (Drs Havey and Martin) and Nephrology-Hypertension (Drs Krumlovsky and delGreco), Department of Medicine, Northwestern University Medical School, Chicago.

JAMA. 1985;254(3):388-393. doi:10.1001/jama.1985.03360030078027

RENOVASCULAR hypertension is responsible for approximately 1% of all cases of hypertension,1-4 and affects as many as 600,000 people in this country alone.5 The current diagnostic approach to the clinically suspect patient involves identification of a renal artery stenotic lesion and determination of its functional significance. The stenotic lesion is usually first detected by a noninvasive screening study, such as radioisotope. renography, intravenous (IV) pyelography, or renal digital-subtraction angiography. Its presence is then confirmed with renal arteriography, and its significance determined by renal vein renin studies.

Renal digital-subtraction angiography has become the noninvasive screening test of choice in many centers6,7 though others8 maintain that the hypertensive IV pyelography is still preferred. Since this controversy is important, we undertook a critical review of the available published data concerning the use of these various noninvasive tests in screening for renovascular hypertension.

Radioisotope Renogram  In