Utility of captopril renal scans for detecting renal artery stenosis

Arch Intern Med. 2002 Sep 23;162(17):1981-4. doi: 10.1001/archinte.162.17.1981.

Abstract

Background: Captopril renal scanning (CRS) is commonly recommended as a noninvasive method for detecting renal artery stenosis (RAS), based on performance characteristics determined in research settings. Scant data are available, however, regarding the utility of CRS in clinical practice.

Methods: We evaluated the performance characteristics (sensitivity, specificity, and predictive values) of CRS in a consecutive series of 90 patients who underwent both CRS and renal arteriography within a 6-month period (January 1, 1991, through December 31, 1995) at a university hospital.

Results: Among 86 eligible patients (and 169 kidneys), the prevalence of RAS was 43%. The sensitivity of CRS was 74% (95% confidence interval [CI], 62%-83%); the specificity was 59% (95% CI, 49%-69%); the positive predictive value was 58% (95% CI, 47%-68%); and the negative predictive value was 75% (95% CI, 64%-84%). Also, there was evidence of spectrum bias, because the sensitivity and specificity (as well as the positive and negative predictive values) were different for groups with and without vascular disease.

Conclusions: The results of CRS were substantially worse in a clinical practice setting than previously reported in research settings, despite a similar prevalence of RAS. Captopril renal scanning should not be used as an initial screening test for diagnosing RAS, even among patients with high clinical likelihood of disease.

Publication types

  • Comparative Study
  • Evaluation Study
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Angiotensin-Converting Enzyme Inhibitors*
  • Captopril*
  • Connecticut / epidemiology
  • False Negative Reactions
  • Follow-Up Studies
  • Humans
  • Magnetic Resonance Angiography
  • Predictive Value of Tests
  • Prevalence
  • Radiography
  • Renal Artery / diagnostic imaging
  • Renal Artery / pathology
  • Renal Artery / surgery
  • Renal Artery Obstruction / diagnosis*
  • Renal Artery Obstruction / epidemiology
  • Renal Artery Obstruction / surgery
  • Sensitivity and Specificity

Substances

  • Angiotensin-Converting Enzyme Inhibitors
  • Captopril