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In their recent article, Huot et al¹ conclude that captopril renography has low sensitivity and specificity and should not be used to screen for renovascular hypertension. Captopril renography clearly has limitations, as previously described.^2-3 However, I believe it would be a grave mistake to discard the test as the authors suggest.

Factors unexplored in the article likely contributed to underestimation of sensitivity and specificity. Two factors may have contributed to underestimation of sensitivity. First, the functional significance of radiographic 75% renal artery stenosis (RAS) is unknown without assessing the response to angioplasty. Since this was not assessed in the study, many scans considered false negative may have actually been true negative. Second, the investigator based sensitivity on the number of ischemic kidneys identified rather than on the number of patients. In patients with bilateral RAS, the asymmetric renogram correctly identifies patients as having renovascular hypertension, but has the limitation of . . . [Full Text of this Article]

RELATED ARTICLE

Captopril Renal Scans for Detecting Renal Artery Stenosis—Reply
Stephen J. Huot and John Concato
Arch Intern Med. 2003;163(5):630-631.
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