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Non-invasive investigations of potential renal artery stenosis in renal insufficiency
Linköping University, Department of Medicine and Health Sciences, Internal Medicine . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Medicine, Department of Nephrology UHL.ORCID iD: 0000-0002.3555-7162
Linköping University, Department of Medicine and Health Sciences, Radiology . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Medical Imaging, Department of Radiology in Linköping.
Linköping University, Department of Medicine and Health Sciences, Radiology . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Medical Imaging, Department of Radiology in Linköping. Linköping University, Center for Medical Image Science and Visualization, CMIV.
Linköping University, Center for Medical Image Science and Visualization, CMIV. Linköping University, Department of Medicine and Health Sciences, Radiology . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Medical Imaging, Department of Radiology in Linköping.ORCID iD: 0000-0003-3124-8044
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2010 (English)In: Nephrology, Dialysis and Transplantation, ISSN 0931-0509, E-ISSN 1460-2385, Vol. 25, no 11, 3607-3614 p.Article in journal (Refereed) Published
Abstract [en]

Background. The diagnostic value of non-invasive methods for diagnosing renal artery stenosis in patients with renal insufficiency is incompletely known.

Methods. Forty-seven consecutive patients with moderately impaired renal function and a clinical suspicion of renal artery stenosis were investigated with computed tomography angiography (CTA), gadolinium-enhanced magnetic resonance angiography (MRA), contrast-enhanced Doppler ultrasound and captopril renography. The primary reference standard was stenosis reducing the vessel diameter by at least 50% on CTA, and an alternative reference standard (‘morphological and functional stenosis’) was defined as at least 50% diameter reduction on CTA or MRA, combined with a positive finding from ultrasound or captopril renography.

Results. The frequency of positive findings, calculated on the basis of individual patients, was 70% for CTA, 60% for MRA, 53% for ultrasound and 30% for captopril renography. Counting kidneys rather than patients, corresponding frequencies were 53%, 41%, 29% and 15%, respectively. In relation to the CTA standard, the sensitivity (and specificity) at the patient level was 0.81 (0.79) for MRA, 0.70 (0.89) for ultrasound and 0.42 (1.00) for captopril renography, and at the kidney level 0.76 (0.82), 0.53 (0.81) and 0.30 (0.86), respectively. Relative to the alternative reference standard, corresponding values at the patient level were 1.00 (0.62) for CTA, 0.90 (0.69) for MRA, 0.91 (1.00) for ultrasound and 0.67 (1.00) for captopril renography, and at the kidney level 0.96 (0.76), 0.85 (0.79), 0.71 (0.97) and 0.50 (0.97), respectively.

Conclusions. CTA and MRA are superior to ultrasound and captopril renography at diagnosing morphological stenosis, but ultrasound may be useful as a screening method and captopril renography for verifying renin-dependent hypertension.

Place, publisher, year, edition, pages
Oxford University Press , 2010. Vol. 25, no 11, 3607-3614 p.
Keyword [en]
computed tomography angiography; magnetic resonance angiography; renal artery stenosis; renography; ultrasound
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-56570DOI: 10.1093/ndt/gfq259ISI: 000283683900025PubMedID: 20488819OAI: oai:DiVA.org:liu-56570DiVA: diva2:320393
Note
Original Publication: Per Eriksson, Ahmed Abdulilah Mohammed, Jakob De Geer, Johan Kihlberg, Anders Persson, Göran Granerus, Fredrik Nyström and Örjan Smedby, Non-invasive investigations of potential renal artery stenosis in renal insufficiency, 2010, Nephrology, Dialysis and Transplantation. http://dx.doi.org/10.1093/ndt/gfq259 Copyright: Oxford University Press http://www.oxfordjournals.org/ Available from: 2010-05-25 Created: 2010-05-25 Last updated: 2017-12-12

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Eriksson, PerDe Geer, JakobKihlberg, JohanPersson, AndersGranerus, GöranNyström, FredrikSmedby, Örjan

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