• Taylor AT Jr, Blaufox MD, Dubovsky EV, Fine EJ, Fommei E, Granerus G, Kahn D, Nally JV Jr, Oei HY, Prigent A, Sfakianakis GN, Treves ST. Procedure guideline for diagnosis of renovascular hypertension, 3.0. Reston (VA): Society of Nuclear Medicine; 2003 Jun 20. 8 p. [27 references]

This is the current release of the guideline.

This guideline updates a previous version: Society of Nuclear Medicine. Procedure guideline for diagnosis of renovascular hypertension, 2.0. Reston (VA): Society of Nuclear Medicine; 1999 Feb. 21 p. (Society of Nuclear Medicine procedure guidelines; no. 2.0).

Background Information and Definitions

Renovascular disease includes renal artery stenosis, renovascular hypertension, and azotemic renovascular disease (ischemic nephropathy). It is important to distinguish between renovascular hypertension and renal artery stenosis. Stenosis of the renal artery is common in nonhypertensive elderly persons and is an associated but nonetiologic finding in a number of hypertensive patients. Renovascular hypertension is defined as an elevated blood pressure caused by renal hypoperfusion, usually resulting from anatomic stenosis of the renal artery and activation of the renin-angiotensin system. Azotemic renovascular disease refers to renal functional impairment associated with renal atrophy, intrarenal vascular lesions, and interstitial nephritis and fibrosis in the presence of severe atherosclerotic renal artery stenosis. Causes of renovascular hypertension in neonates and infants include renal artery thrombosis after umbilical artery catheterization and coarctation of the aorta. The goal of a screening test for renovascular hypertension in adults is to detect those patients who have renal artery stenosis as the cause of hypertension and to predict curability or amelioration of hypertension following intervention.

Renovascular hypertension is estimated to affect fewer than 1 to 3% of the unselected hypertension population and up to 15 to 30% of patients referred to a subspecialty center because of refractory hypertension. Clinical features should indicate which patients have moderate or high risk of renovascular hypertension. Clues include abrupt or severe hypertension, hypertension resistant to 3-drug therapy, bruits in the abdomen or flank, unexplained azotemia or recurrent pulmonary edema in an elderly hypertensive patient, or worsening renal function during therapy with angiotensin-converting enzyme (ACE) inhibitors (ACEIs). ACEI renography is designed to be a test for renovascular hypertension, not for renal artery stenosis. The optimal reference test or "gold standard" in future studies should be the outcome--the response to successful revascularization--not angiographic evidence of renal artery stenosis.

Common Indications

The test is most cost-effective if used primarily in patients who have a moderate-to-high risk of having renovascular hypertension. Clinical features associated with a moderate to high risk of renovascular hypertension have been published and include:

• Abrupt or severe hypertension
• Hypertension resistant to 3-drug therapy in a compliant patient
• Abdominal or flank bruits
• Unexplained azotemia in an elderly hypertensive patient
• Worsening renal function during antihypertensive therapy, especially with ACEIs or angiotensin II receptor blockers
• Grade 3 or 4 hypertensive retinopathy
• Occlusive disease in other vascular beds
• Onset of hypertension under age 30 years or over age 55 years
• Recurrent pulmonary edema in an elderly hypertensive patient
• Hypertension in infants with an umbilical artery catheter
• Hypertension in children

Procedure

The detailed procedure recommendations in the guideline address the following areas: patient preparation; information pertinent to performing the procedure (i.e., important data that the physician should have about the patient at the time the exam is performed and interpreted); precautions; information regarding the radiopharmaceutical (i.e., ranges of administered activity, organ receiving the largest radiation dose, effective dose); image acquisition; interventions; processing; interpretation/reporting; quality control; and sources of error.

None provided

The type of evidence supporting the recommendations is not specifically stated.

• Taylor AT Jr, Blaufox MD, Dubovsky EV, Fine EJ, Fommei E, Granerus G, Kahn D, Nally JV Jr, Oei HY, Prigent A, Sfakianakis GN, Treves ST. Procedure guideline for diagnosis of renovascular hypertension, 3.0. Reston (VA): Society of Nuclear Medicine; 2003 Jun 20. 8 p. [27 references]

Not applicable: The guideline was not adapted from another source.

1999 Feb (updated 2003 Jun 20)

Society of Nuclear Medicine, Inc - Medical Specialty Society

Society of Nuclear Medicine (SNM)

Task Force

Authors: Andrew T. Taylor, Jr., MD (Emory University School of Medicine, Atlanta, GA); M. Donald Blaufox, MD, PhD (Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY); Eva V. Dubovsky, MD, PhD (University of Alabama Hospital, Birmingham, AL); Eugene J. Fine, MD (Jacobi Medical Center, Bronx, NY); Enza Fommei, MD (Pisa, Italy); Göran Granerus, MD, PhD (Linköping, Sweden); Daniel Kahn, MD (VA Medical Center and University of Iowa College of Medicine, Iowa City, IA); Joseph V. Nally, Jr., MD (Cleveland Clinic, Cleveland, OH); Hong-Yoe Oei, MD, PhD (Rotterdam, The Netherlands); Alain Prigent, MD (Paris, France); and George N. Sfakianakis, MD, PhD (University of Miami School of Medicine, Miami, FL); and S. Ted Treves, MD (Harvard University, Boston, MA)

Not stated

This is the current release of the guideline.

This guideline updates a previous version: Society of Nuclear Medicine. Procedure guideline for diagnosis of renovascular hypertension, 2.0. Reston (VA): Society of Nuclear Medicine; 1999 Feb. 21 p. (Society of Nuclear Medicine procedure guidelines; no. 2.0).

None available

This summary was completed by ECRI on July 20, 1999. It was verified by the guideline developer as of August 5, 1999. This summary was updated by ECRI on April 14, 2005.

This NGC summary is based on the original guideline, which is subject to the guideline developer's copyright restrictions.