Diagnosis of Renal Artery Stenosis. Ann Intern Med. 2004;141:I-66. doi: 10.7326/0003-4819-141-9-200411020-00003
Download citation file:
Published: Ann Intern Med. 2004;141(9):I-66.
Renal artery stenosis is a narrowing of the artery that supplies blood to the kidney. It can cause kidney dysfunction and high blood pressure. One of the most accurate ways to detect renal artery stenosis is to x-ray the renal arteries after injecting them directly with dye. This test, called intra-arterial digital subtraction angiography, or DSA, is invasive and sometimes dangerous. Thus, physicians often use alternative tests, such as computed tomographic angiography (CTA) and magnetic resonance angiography (MRA), to detect renal artery stenosis. These tests show pictures of arteries that have been injected with very small amounts of dye. Computed tomographic angiography uses x-ray beams and MRA uses radio waves and a magnetic field to take the pictures. Unfortunately, few studies address how well either of these tests detects renal artery stenosis.
To see if CTA and MRA are reliable, accurate tests for detecting renal artery stenosis.
402 hypertensive adults with suspected renal artery stenosis from 6 hospitals in the Netherlands.
The researchers recruited hypertensive patients who had at least 1 historical, physical, or laboratory finding that suggested the possibility of renal artery stenosis. Within a 3-month period, each patient had CTA, MRA, and DSA. Two panels of 3 trained physicians who had no knowledge of other test results interpreted the CTA and MRA images. The researchers then assessed whether the physicians' interpretations agreed and also compared the results of CTA and MRA with DSA results.
The physicians sometimes disagreed about whether CTA and MRA showed renal artery stenosis. These tests detected only 64% and 62%, respectively, of the patients who had DSA findings of renal artery stenosis.
The comparison standard test, DSA, is not a perfect test for diagnosing renal artery stenosis.
Even trained physicians may have difficulty interpreting CTA and MRA. In this study, neither CTA nor MRA was a sensitive test for detecting renal artery stenosis.
The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.
Results provided by:
Copyright © 2016 American College of Physicians. All Rights Reserved.
Print ISSN: 0003-4819 | Online ISSN: 1539-3704
Conditions of Use
This PDF is available to Subscribers Only