SUMMARY Angiotensin converting enzyme (ACE) inhibitor-induced renal failure has been reported in bilateral renal artery stenosis and in stenosis in solitary kidneys, but not in unilateral renal artery stenosis. In these patients, however, a functional impairment of the kidney ipsilateral to the stenosis can often be detected after ACE inhibition by scintigraphic techniques employing glomerular radionuclide tracers like 99n>Tc-diethylenetriamine pentaacetic acid (DTPA). Dynamic renal scintigraphy with "Tc-DTPA before and 1 hour after administration of captopril, 25 mg (renal scintigraphic captopril test; RSCT), was performed in a selected series of 39 hypertensive subjects with suspected renovascular hypertension. Changes in glomerular filtration rate induced by captopril on the individual kidney were estimated by assessing the early (120-180 seconds) DTPA uptake by the kidney. Values were expressed as the ratio between the kidney with the lower uptake and the contralateral one in 34 patients and as the ratio of the kidney counts to the injected dose in five patients with solitary kidneys, aortic coarctation, or both. Compared with precaptopril values, postcaptopril uptake decreased markedly in 14 subjects ( - 62.42 ± 30.94 [SD]%; range, - 25 to -100%) and decreased modestly or even increased in the other 25 (+ 0.57 ± 9.83%; range, + 28 to -13%). Of the 14 subjects considered to be RSCT-positive diagnostic workup revealed either established (10) or strongly suspected (2) renal artery stenosis in 12 and aortic coarctation in 2 subjects. In another patient with established renovascular hypertension, results of the RSCT were negative when performed in the supine position but became positive when repeated in the sitting position. Nine patients underwent repair of stenosis by either operation or angioplasty, and a striking correspondence was observed between response to RSCT and success of intervention. Taken together these findings strongly suggest that renal scintigraphy after ACE inhibition represents a promising tool for diagnosis of renovascular hypertension and its follow-up after operation or angioplasty.
Renal scintigraphic Captopril test in the diagnosis of renovascular hypertension
FOMMEI, ENZA;MOSCA, FRANCO;FERRARI, MAURO;PALOMBO, CARLO;
1987-01-01
Abstract
SUMMARY Angiotensin converting enzyme (ACE) inhibitor-induced renal failure has been reported in bilateral renal artery stenosis and in stenosis in solitary kidneys, but not in unilateral renal artery stenosis. In these patients, however, a functional impairment of the kidney ipsilateral to the stenosis can often be detected after ACE inhibition by scintigraphic techniques employing glomerular radionuclide tracers like 99n>Tc-diethylenetriamine pentaacetic acid (DTPA). Dynamic renal scintigraphy with "Tc-DTPA before and 1 hour after administration of captopril, 25 mg (renal scintigraphic captopril test; RSCT), was performed in a selected series of 39 hypertensive subjects with suspected renovascular hypertension. Changes in glomerular filtration rate induced by captopril on the individual kidney were estimated by assessing the early (120-180 seconds) DTPA uptake by the kidney. Values were expressed as the ratio between the kidney with the lower uptake and the contralateral one in 34 patients and as the ratio of the kidney counts to the injected dose in five patients with solitary kidneys, aortic coarctation, or both. Compared with precaptopril values, postcaptopril uptake decreased markedly in 14 subjects ( - 62.42 ± 30.94 [SD]%; range, - 25 to -100%) and decreased modestly or even increased in the other 25 (+ 0.57 ± 9.83%; range, + 28 to -13%). Of the 14 subjects considered to be RSCT-positive diagnostic workup revealed either established (10) or strongly suspected (2) renal artery stenosis in 12 and aortic coarctation in 2 subjects. In another patient with established renovascular hypertension, results of the RSCT were negative when performed in the supine position but became positive when repeated in the sitting position. Nine patients underwent repair of stenosis by either operation or angioplasty, and a striking correspondence was observed between response to RSCT and success of intervention. Taken together these findings strongly suggest that renal scintigraphy after ACE inhibition represents a promising tool for diagnosis of renovascular hypertension and its follow-up after operation or angioplasty.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
