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Diagnostic Tests for Renal Artery Stenosis in Patients Suspected of Having Renovascular Hypertension: A Meta-Analysis

G. Boudewijn C. Vasbinder, MD; Patricia J. Nelemans, MD, PhD; Alfons G.H. Kessels, MD, MSc; Abraham A. Kroon, MD, PhD; Peter W. de Leeuw, MD, PhD; and Jos M.A. van Engelshoven, MD, PhD
[+] Article and Author Information

From University Hospital of Maastricht, Maastricht, the Netherlands.


Grant Support: By the Dutch Health Care Insurance Board (OG 97-003).

Requests for Single Reprints: G. Boudewijn C. Vasbinder, MD, Department of Radiology, Box 5800, University Hospital of Maastricht, NL-6202 AZ Maastricht, the Netherlands; e-mail, bvas@rdia.azm.nl.

Current Author Addresses: Drs. Vasbinder, Nelemans, Kessels, Kroon, de Leeuw, and van Engelshoven: Department of Radiology, Box 5800, University Hospital of Maastricht, NL-6202 AZ Maastricht, the Netherlands.

Author Contributions: Conception and design: G.B.C. Vasbinder, P.J. Nelemans, P.W. de Leeuw, J.M.A. van Engelshoven.

Analysis and interpretation of the data: G.B.C. Vasbinder, P.J. Nelemans, J.M.A. van Engelshoven.

Drafting of the article: G.B.C. Vasbinder, P.J. Nelemans, A.A. Kroon.

Critical revision of the article for important intellectual content: G.B.C. Vasbinder, P.J. Nelemans, A.G.H. Kessels, A.A. Kroon, P.W. de Leeuw, J.M.A. van Engelshoven.

Final approval of the article: G.B.C. Vasbinder, P.J. Nelemans, A.G.H. Kessels, A.A. Kroon, P.W. de Leeuw, J.M.A. van Engelshoven.

Provision of study materials or patients: G.B.C. Vasbinder.

Statistical expertise: P.J. Nelemans, A.G.H. Kessels.

Obtaining of funding: J.M.A. van Engelshoven.

Collection and assembly of data: G.B.C. Vasbinder, P.J. Nelemans.


Ann Intern Med. 2001;135(6):401-411. doi:10.7326/0003-4819-135-6-200109180-00009
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In a general hypertensive population, the prevalence of renovascular disease varies between 1% and 5% (12). In patients who exhibit specific clinical clues that indicate renovascular hypertension, the probability of having the disease increases to 20% to 40% (3). Renovascular hypertension is currently treated with drugs; surgery; or less invasive techniques, such as percutanous transluminal renal angioplasty with or without stent placement. A recent study found no significant difference between treatment with percutanous transluminal renal angioplasty and antihypertensive drug therapy. However, in that study, 44% of patients who received drug therapy still received percutanous transluminal renal angioplasty (4). Because a large proportion of patients are still preferably treated with angioplasty, a valid diagnostic test is needed in the presence of one or more clinical clues (5). Intra-arterial x-ray angiography is considered the gold standard; however, it is invasive and carries small risks for serious complications, such as arterial dissection or adverse contrast reactions.

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Figures

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For each diagnostic technique, the concurrent summary ROC curve is shown. The boldface, diagonal line indicates the point at which sensitivity equals 1 − specificity. Because data for computed tomography angiography ( ) and gadolinium-enhanced magnetic resonance angiography ( ) were nearly identical, both tests are represented by the same line pattern.
Figure 1. Summary receiver-operating characteristic (ROC) curves.CTAMRA
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Figure 2.
Differences between the areas under the summary receiver-operating characteristic (ROC) curve for a particular test and the area under the summary ROC curve for the reference test (ultrasonography).

Values in parentheses are 95% CIs. CTA = computed tomography angiography; MRA = magnetic resonance angiography.

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Figure 3.
Differences between the areas under the summary receiver-operating characteristic (ROC) curve for studies with and without the evaluated study characteristic.

Values in parentheses are 95% CIs.

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Summary for Patients

Diagnosis of Renal Artery Stenosis

The summary below is from the full report titled “Diagnostic Tests for Renal Artery Stenosis in Patients Suspected of Having Renovascular Hypertension: A Meta-Analysis.” It is in the 18 September 2001 issue of Annals of Internal Medicine (volume 135, pages 401-411). The authors are GBC Vasbinder, PJ Nelemans, AGH Kessels, AA Kroon, PW de Leeuw, and JMA van Engelshoven.

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