Captopril renal scintigraphy: A new standard for predicting outcome after renal revascularization

• Published in: Journal of vascular surgery Vol. 17; no. 2; pp. 280 - 287
• Main Authors: Meier, George Henry, Sumpio, Bauer, Setaro, John Francis, Black, Henry Richard, Gusberg, Richard Jefferson
• Format: Journal Article
• Language: English
• Published: United States Mosby, Inc 01.02.1993
• Subjects: Adult; Aged; Aged, 80 and over; Angioplasty, Balloon; Blood Pressure - drug effects; Captopril - administration & dosage; Evaluation Studies as Topic; Female; Glomerular Filtration Rate - drug effects; Humans; Hypertension, Renovascular - diagnostic imaging; Hypertension, Renovascular - epidemiology; Hypertension, Renovascular - physiopathology; Hypertension, Renovascular - therapy; Kidney - blood supply; Kidney - drug effects; Kidney - physiopathology; Kidney - surgery; Male; Middle Aged; Prognosis; Prospective Studies; Radioisotope Renography - methods; Radioisotope Renography - statistics & numerical data; Renal Artery
• ISSN: 0741-5214; 1097-6809
• DOI: 10.1016/0741-5214(93)90413-G

Purpose: Captopril renal scintigraphy (CRS) is a nuclear medicine technique for evaluating each kidney independently for changes in glomerular filtration rate and perfusion induced by captopril-associated alterations in vascular tone. This study was undertaken to determine the role of CRS in predicting the response to renal revascularization. Methods: The study group consisted of all patients who underwent preintervention CRS and arteriography, followed by renal revascularization performed between December 1987 and February 1992. After cessation of administration of angiotensin-converting enzyme inhibitors for 48 hours, a standard renogram was obtained, a 50 mg dose of captopril was given, and a second renogram was obtained. A captopril-induced change in the renogram was present when a normal pre-captopril renogram became abnormal after captopril administration. An abnormal baseline scan by definition cannot have a captopril-induced change. Blood pressure before revascularization was compared with blood pressure at 3 to 6 months after the procedure according to American Heart Association criteria for hypertension response. Results: Fifty patients received renal revascularization by operation (28 patients) or balloon angioplasty (22 patients). Preoperative captopril-induced changes were present in 29 of the 50 patients. Among the 29 patients with captopril-induced changes, hypertension was cured or improved in 26. When captopril-induced changes were not present, only one of 21 patients improved (p < 0.00001). Conclusion: On the basis of these data, CRS appears to reliably predict hypertension response to revascularization in patients with renovascular disease.