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William H. Bush, MD; Reiley Kidd, MD
The Mason Clinic and Virginia Mason Medical Center Seattle

JAMA. 1986;255(5):612-613.

	Since this article does not have an abstract, we have provided the first 150 words of the full text PDF and any section headings.

To the Editor.—

The article by Dr Havey et al, entitled "Screening for Renovascular Hypertension," is a most interesting review of this subject.¹ The authors have done extensive research in hopes of elucidating the role of the hypertensive intravenous pyelogram (IVP) and digital-subtraction angiography (DSA) in detecting renal artery stenosis. Their summary (Tables 2 and 3) concerning the sensitivities and specificities of the rapidsequence IVP and renal DSA finds that these numbers are similar. Moreover, the predictive values of the tests (Table 4) are essentially equal. Because of the high cost of DSA and its false-negative rate due to technical factors, the authors conclude that a well-performed, rapid-sequence IVP is the best test for detecting renal artery stenosis.

Unfortunately, the authors barely address one significant problem with using the hypertensive urogram to screen for renal artery stenosis: the prevalence of bilateral lesions (p 390). As they mention, bilateral lesions . . . [Full Text PDF of this Article]

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