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Screening for Renal Artery Stenosis: Are Scans More Accurate Than Clinical Criteria?

Christopher S. Wilcox, MD, PhD
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Georgetown University Medical Center; Washington, DC 20007 Requests for Reprints: Christopher S. Wilcox, MD, PhD, Georgetown University Medical Center, Division of Nephrology and Hypertension, 3800 Reservoir Road, NW, PHC F6003, Washington, DC 20007.

Copyright ©2004 by the American College of Physicians

Ann Intern Med. 1998;129(9):738-740. doi:10.7326/0003-4819-129-9-199811010-00011
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Deciding which patients with hypertension to investigate for renal artery stenosis remains one of the most perplexing and controversial decisions facing the internist. No screening test has been sufficiently accurate, inexpensive, noninvasive, reproducible, and adequately validated in practice settings to be accepted universally as a screening procedure. Ideally, the first step in diagnosis is to identify a group of patients with a prevalence of renal artery stenosis that is high enough to justify screening, the second step is to select a test with a high sensitivity, and the third step is to perform arteriography in patients who have positive test results. However, scrutiny of this apparently reasonable process shows that it has been heretofore unsuccessful.

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