Screening for Renovascular Hypertension

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Abstract
RENOVASCULAR hypertension is responsible for approximately 1% of all cases of hypertension,1-4and affects as many as 600,000 people in this country alone.5The 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 centers6,7though others8maintain 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