Authors' objectives:

The aims of this study were as follows: 1. Assess the diagnostic performance of methods of investigating renal artery stenosis, 2. Determine the minimum technical requirements for each method, 3. Establish the role of each method in diagnosis, as given by its benefits and risks.

Authors' results and conclusions: Plasma renin assay and captopril renography are functional examinations, limited in scope and used in addition to other forms of investigation. Diagnostic efficacy is poor, particularly sensitivity, especially in patients with renovascular hypertension or renal failure. Renal scintigraphy is a functional test which may complement other investigations to determine the cause of the arterial stenosis or help decide on treatment by attempting to predict outcome. The many diagnostic criteria complicate analysis and interpretation. Doppler ultrasound has low reproducibility (operator- and machine-dependent), a high failure rate, and takes time. Advantages include an absence of side-effects and the possibility of repeat examinations without adverse effects. There are many diagnostic criteria. Diagnostic performance varies from study to study. It may be used as a first or second line test to measure the resistive index before deciding on revascularisation. This is useful for establishing response to therapy. Spiral CT-angiography is reproducible, widely available and has highly satisfactory diagnostic efficacy. The technological improvements provided by multi-array scanning enable the study of morphological indicators of early renal disease. The examination is limited by contraindications due to nephrotoxicity and radiation. It may be used as first choice. Magnetic resonance angiography is reproducible, well tolerated and its diagnostic performance is satisfactory (but lower for stenosis related to fibromuscular dysplasia). Its main contraindication is a metal implant. It not widely available and gives false positives, making it a second-line test. It is mostly used after Doppler ultrasound or CT-angiography.

Authors' recommendations: Comparisons with arteriography (gold standard) suggest that the diagnostic performance of the morphological examinations (i.e. CT-angiography and angiography) is better than that of the others. This study does not propose any algorithms for the diagnostic strategy because it is difficult to take into account local arrangements and patient profiles and because the indications of revascularisation and its efficacy need to be assessed beforehand. Only then can a study be performed. It should give rise to professional practice guidelines.

Authors' methods: Systematic review

Project Status: Completed

URL for project: http://www.has-sante.fr/

Year Published: 2004

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: France

Organisation Name: L'Agence Nationale d'Accreditation d'Evaluation en Santé

Contact Address: 2 avenue du Stade de France, 93218 Saint-Denis La Plaine Cedex, France. Tel: +33 01 55 93 71 88; Fax: +33 01 55 93 74 35;

Contact Name: sh.leerobin@has-sante.fr

Contact Email: sh.leerobin@has-sante.fr

Copyright: L'Agence Nationale d'Accreditation d'Evaluation en Sante (ANAES)