Renovascular hypertension: Prospective diagnostic yield in a random access population

Abstract Over a five-year period, 104 patients with diastolic hypertension were clinically evaluated and studied by arteriography, differential renal function studies, and radioisotopic renography. Based on either a positive differential renal function study and/or response to surgery, the incidence of renovascular hypertension was determined to be 6 per cent. Of the entire group studied, 15 per cent ( 16 104 ) of patients were found to have renal artery stenosis by arteriography. Eight of these patients had normal differential function studies and were excluded from the renovascular group. In the group with a final diagnosis of essential hypertension (87), 22 patients met roentgen criteria for chronic pyelonephritis. All 6 patients with renovascular hypertension had abnormal renograms; 5 of 8 patients with renal artery stenosis and normal differential function studies had abnormal renograms. However, there was an incidence of 15 per cent false positive renograms. Differential renal function studies were carried out on 75 patients, utilizing a modification of the Stamey technique. Of the 6 patients with renovascular hypertension, 2 had negative results on tests by Stamey's criteria; 2 had negative findings on tests by Rapoport's criteria; and there was 1 negative result on a test utilizing PAH (para-aminohippuric acid) excretion ratios as criteria.