Distal Vessel Atherosclerosis as a Cause for False-Positive Renal Scintigraphy

• Published in: Renal failure Vol. 18; no. 6; pp. 923 - 930
• Main Authors: Cristol, Louis, Walker, Brandy, Henrich, William L.
• Format: Journal Article
• Language: English
• Published: Colchester Informa UK Ltd 1996; Taylor & Francis
• Subjects: Adult; Arteriosclerosis - complications; Arteriosclerosis - diagnostic imaging; Arteriosclerosis - physiopathology; Biological and medical sciences; Captopril - administration & dosage; Diagnosis, Differential; False Positive Reactions; Follow-Up Studies; Humans; Investigative techniques, diagnostic techniques (general aspects); Medical sciences; Middle Aged; Radionuclide Imaging; Radionuclide investigations; Renal Artery - diagnostic imaging; Renal Artery - pathology; Renal Artery Obstruction - diagnostic imaging; Renal Artery Obstruction - etiology; Renal Artery Obstruction - physiopathology; Retrospective Studies; Sensitivity and Specificity; Urinary system; Radionuclide study; Human; Renal artery; False positive; Arteriole; Captopril; Pathogenesis; Stenosis; Cardiovascular disease; Scintigraphy; Kidney; Arterial disease; Vascular disease; Atherosclerosis; Medical imagery; Renal artery disease
• ISSN: 0886-022X; 1525-6049
• DOI: 10.3109/08860229609047718

While captopril-enhanced renal scintigraphy is acknowledged to be a useful screening technique to detect clinically silent obstructive lesions of the main renal arteries, the presence of significant atherosclerosis of distal, smaller renal vessels as a cause of positive scintigraphy scans has not been reported extensively. In a retrospective 2-year analysis of 31 consecutive captopril-enhanced renal scintigrams, we found a total of 13 studies in 11 patients that were classified as "positive "for renal artery stenosis. Of these 11 patients with positive scintigraphic studies, 4 patients underwent 5 renal arteriography procedures; only 1 of these renal arteriograms showed significant stenosis of the main renal artery. In the other 4 cases, an angiographic pattern of diffuse intrarenal distal arterial disease correlated with scintigram lateralization. Angiography was also performed in 4 patients with negative captopril renal scintiscans. In each of these cases the arteriogram was also negative for significant renal artery stenosis, and only 1 patient had diffuse bilateral intrarenal arterial disease. We conclude that distal renal arterial narrowing should be considered in the differential diagnosis of lateralized renal scintigrams. A negative renal scintigraphic study may be more reliable for excluding significant main renal artery obstructive disease.