Prospective study of simultaneous orthoiodohippurate and diethylenetriaminepentaacetic acid captopril renography

M. Donald Blaufox, Eugene J. Fine, Sherman Heller, James Hurley, Marcy Jagust, Yi Li, Samuel J. Mann, Thomas G. Pickering, Patrick Zanzonico, Cheng Gang Zhang

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36 Scopus citations

Abstract

Captopril renography (CR) has been established in the past 10 yr as a useful diagnostic test for renovascular hypertension. However, direct comparison of tubular and glomerular tracers, quantitative criteria, comparison of quantitative and qualitative results and the reliability of the results in renal failure have not been described in a systematic, prospective fashion. Methods: Same-day baseline and CR using 99mTc-labeled diethyleneriaminepentaacetic acid (DTPA) and [131]orthoiodohippurate (OIH) were simultaneously performed in two groups of hypertensive subjects, one with demographically defined essential hypertension (n = 43) and the other (n = 60) with a high prevalence of renovascular disease, defined with angiograms. Quantitative criteria for abnormal CR were derived from results among the subjects with essential hypertension. Qualitative analysis was performed using widely established criteria. Results: There were no statistically significant differences between quantitative and qualitative accuracy, between OIH and DTPA or among quantitative parameters. The best accuracies for quantitative CR were 56% with DTPA (n = 57) and 60% with OIH (n = 60), in both cases using the relative renal uptake parameter. Qualitative CR (n = 60) had accuracies of 43% (DTPA) and 50% (OIH), but hindered by 29 (DTPA) and 25 (OIH) abnormal but nondiagnostic studies. Two false-positive studies were detected. Twenty-seven of 29 nondiagnostic studies were associated with a glomerular filtration rate of <50 ml/min (n = 17), one small kidney (n = 17) and/or bilateral renal artery stenosis (n = 16). Supplemental measurement of in vitro stimulated plasma renin activity insignificantly (p > 0.10) and improved accuracies to 63% (DTPA) and 70% (OIH), without introducing additional false-positive tests. Conclusion: Orthoiodohippurate and DTPA have comparable accuracy in prospective simultaneous evaluation of CR. False-positive studies are fewer than 5%. The accuracies of quantitative and qualitative criteria do not differ significantly but may be improved by supplemental use of the in vitro stimulated plasma renin activity. In individuals with renal insufficiency, small kidneys and/or bilateral renal artery disease, up to 48% of CR studies are abnormal but nondiagnostic.

Original languageEnglish (US)
Pages (from-to)522-528
Number of pages7
JournalJournal of Nuclear Medicine
Volume39
Issue number3
StatePublished - Mar 1 1998
Externally publishedYes

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Keywords

  • Captopril renography
  • Renal insufficiency
  • Renovascular hypertension

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

Cite this

Blaufox, M. D., Fine, E. J., Heller, S., Hurley, J., Jagust, M., Li, Y., Mann, S. J., Pickering, T. G., Zanzonico, P., & Zhang, C. G. (1998). Prospective study of simultaneous orthoiodohippurate and diethylenetriaminepentaacetic acid captopril renography. Journal of Nuclear Medicine, 39(3), 522-528.