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January 18, 1985

Diagnosis of Unilateral Renal Artery Lesions After Captopril Administration-Reply

JAMA. 1985;253(3):346-347. doi:10.1001/jama.1985.03350270040017

In Reply.—  Let us stress the following points. Dr Grim considers our data preliminary. He does not seem to be aware that, when our article was published in January 1984, at least five other articles (besides the article by Lyons et al quoted by Dr Grim) had already shown the usefulness of converting enzyme inhibition for investigating renal vein renin ratios in renovascular hypertension.1-5Dr Grim states that the diagnosis of a renal artery lesion causing hypertension is retrospective, based on the sustained cure (for how long?) of the hypertension by the surgical intervention. This implies that we ought to operate on all our patients to confirm or exclude such a diagnosis. This is not reasonable, and we prefer to use the three positive diagnostic criteria (functional, biochemical, and anatomic) proposed by Izzo6 in a recent editorial in this journal.Dr Grim reproaches us for not presenting evidence