Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Article
  • Published:

Renovascular disease in patients with hypertension: detection with duplex ultrasound

Journal of Human Hypertension volume 16, pages 501–507 (2002)Cite this article

Abstract

The aim of this study was to evaluate the accuracy of duplex ultrasound for the diagnosis of renovascular disease in a cohort of hypertensive patients. In 78 patients suspected of renovascular hypertension on clinical grounds duplex ultrasound examination of the renal arteries was performed. Renal angiography was used as the standard of reference. Duplex ultrasound was inconclusive in 11 kidneys (7%). None of the supernumerary renal arteries was detected with duplex ultrasound. The overall prevalence of significant renovascular disease (⩾50% stenosis) was 20%. Based on the combination of parameters at thresholds commonly applied in current literature: ie PSVmax >180 cm/sec and RAR >3.5 the overall sensitivity of duplex ultrasound for detection of haemodynamically significant renovascular disease was 50.0% with a specificity of 91.3% (PPV: 87.9%; NPV: 59.1). Lowering the thresholds for both parameters improved the test results at the cost of a significant increase of false positive examinations. In a population of hypertensive patients clinically suspected of renovascular hypertension, only limited results for duplex ultrasound could be acquired in the detection of renovascular disease. This result, in combination with the wide range of sensitivities and specificities published in international literature and the relatively large number of incomplete examinations does not support the general application of duplex ultrasound as a screening procedure for detection and assessment of renovascular disease.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Figure 1
Figure 2

Similar content being viewed by others

References

  1. Jensen G et al. Treatment of renovascular hypertension: one year results of renal angioplasty Kidney Int 1995; 48: 1936–1945

    Article  CAS  Google Scholar 

  2. Christensson A . Renovascular disease and renal insufficiency – diagnosis and treatment Scand J Urol Nephrol 1999; 33: 400–405

    Article  CAS  Google Scholar 

  3. Erdoes LS, Berman SS, Hunter GC, Mills JL . Comparative analysis of percutaneous transluminal angioplasty and operation for renal revascularisation Am J Kidney Dis 1996; 4: 496–503

    Article  Google Scholar 

  4. Hillman BJ . Imaging advances in the diagnosis of renovascular hypertension AJR 1989; 153: 5–14

    Article  CAS  Google Scholar 

  5. Kim D et al. Abdominal aorta and renal artery stenosis: evaluation with MR Angiography Radiology 1990; 174: 727–731

    Article  CAS  Google Scholar 

  6. Yucel KE . Magnetic resonance angiography of the lower extremity and the renal arteries Semin Ultrasound, CT and MRI 1992; 13: 291–302

    CAS  Google Scholar 

  7. Davidson RA, Wilcox CS . Newer tests for the diagnosis of renovascular disease, captopril renogram JAMA 1992; 268: 3353–3358

    Article  CAS  Google Scholar 

  8. Baxter GM et al. Colour Doppler ultrasound in renal artery stenosis: intrarenal waveform analysis Br J Radiol 1996; 69: 810–815

    Article  CAS  Google Scholar 

  9. Breitenseher von M et al. Screening of renal artery stenosis: early results of colour Doppler sonography Fortschr Röntgenstr 1992; 156: 228–231

    Article  Google Scholar 

  10. Oliva V et al. Detection of renal artery stenosis with Doppler sonography before and after administration of captopril: value of early systolic rise AJR 1998; 170: 169–175

    Article  CAS  Google Scholar 

  11. Strotzer M et al. Non-invasive assessment of renal artery stenosis: a comparison of MR angiography, color Doppler sonography, and intaarterial angiography Acta Radiologica 1995; 36: 143–247

    Article  Google Scholar 

  12. Kaplan S, Nadja C . Captopril renography and duplex Doppler sonography in the diagnosis of renovascular hypertension Nephrol Dialysis Transplant 1998; 13: 313–317

    Article  Google Scholar 

  13. Claudon M et al. Renal arteries inpatients at risk of renal artery stenosis: multicenter evaluation of the echo-enhancer SH U 508A at color and spectral Doppler US Radiology 2000; 214: 739–746

    Article  CAS  Google Scholar 

  14. van Jaarsveld BC et al. The effect of balloon angioplasty on hypertension in atherosclerotic renal-artery stenosis. Dutch Renal Artery Stenosis Intervention Co-operative Study Group N Engl J Med 2000; 342: 1007–1014

    Article  CAS  Google Scholar 

  15. Berland L, Koslin D, Routh W, Keller F . Renal artery stenosis: prospective evaluation of diagnosis with color duplex ultrasound compared with angiography Radiology 1990; 174: 421–423

    Article  CAS  Google Scholar 

  16. Desberg A et al. Renal artery stenosis: evaluation with color doppler flow imaging Radiology 1990; 177: 749–753

    Article  CAS  Google Scholar 

  17. Radermacher J et al. Use of Doppler Ultrasonography to predict the outcome of therapy for renal-artery stenosis N Engl J Med 2001; 344: 410–417

    Article  CAS  Google Scholar 

  18. Radermacher J et al. Detection of significant renal artery stenosis with color Doppler sonography: combining extrarenal and intrarenal approaches to minimize technical failure Clin Nephrol 2000; 53: 333–343

    CAS  PubMed  Google Scholar 

  19. Miralles M et al. Renal duplex scanning: correlation with angiography and isotopic renography Eur J Vasc Surg 1993; 7: 188–194

    Article  CAS  Google Scholar 

  20. Olin JW et al. The utility of duplex ultrasound scanning of the renal arteries for diagnosing significant renal artery stenosis Annals Int Med 1995; 122: 833–838

    Article  CAS  Google Scholar 

  21. Miralles M et al. Value of Doppler parameters in the diagnosis of renal artery stenosis J Vasc Surg 1996; 23: 428–435

    Article  CAS  Google Scholar 

  22. Vigna C et al. Comparison of steerable continuous-wave versus pulsed-wave Doppler ultrasound to renal artery angiography in diagnosing renal artery stenosis Am J Cardiol, 1998; 81: 365–367

    Article  CAS  Google Scholar 

  23. House MK, Dowling RJ, King P, Gibson RN . Using Doppler sonography to reveal renal artery stenosis: an evaluation of optimal imaging parameters AJR 1999; 173: 761–765

    Article  CAS  Google Scholar 

  24. Bardelli M, Jensen G . Vlokmann R, Aurell M. Non-invasive ultrasound assessment of renal artery stenosis by means of the Gosling pulsatility index J Hypertens 1992; 10: 985–989

    Article  CAS  Google Scholar 

  25. Schwerk WB et al. Renal artery stenosis: grading with image-directed Doppler US evaluation of renal resistive index Radiology 1994; 190: 786–790

    Article  Google Scholar 

  26. Strunk H, Jaeger U, Teifke A . Intrarenal colour-coded duplex sonography in the diagnosis of renal artery stenosis with special regard to multiple renal arteries: analysis of Doppler waveform and “tardus-parvus” phenomenon Ultraschall in Med 1995; 16: 172–179

    Article  Google Scholar 

  27. Pedersen EB et al. Diagnosing renal artery stenosis: a comparison between conventional renography, captopril renography and ultrasound Doppler in a large consecutive series ofpatients with arterial hypertension Blood Press 1996; 5: 342–348

    Article  CAS  Google Scholar 

  28. Postma CT, Bijlsta PJ, Rosenbusch G, Thien Th . Pattern recognition of loss of early systolic peak by Doppler ultrasound has a low sensitivity for the detection of renal artery stenosis J Hum Hypertens 1996; 10: 181–184

    CAS  PubMed  Google Scholar 

  29. Lucas P, Blome S, Roche J . Intra-renal Doppler wave-form analysis as a screening test for renal artery stenosis Austr Radiol 1996; 40: 276–282

    Article  CAS  Google Scholar 

  30. Johansson M et al. Evaluation of duplex ultrasound and captopril renography for detection of renovascular hypertension Kidney Int 2000; 58: 774–782

    Article  CAS  Google Scholar 

  31. Kliewer MA et al. Renal artery stenosis: analysis of Doppler waveform parameters and parvus-tardus pattern Radiology 1993; 189: 779–787

    Article  CAS  Google Scholar 

  32. Malatino LS et al. Diagnosis of renovascular disease by extra and intrarenal Doppler parameters Angiology 1998; 49: 707–721

    Article  CAS  Google Scholar 

  33. Grenier N, Trillaud H . Comparison of imaging methods for renal artery stenosis BJU Int 2000; 86 (Suppl 1): 84–94

    Google Scholar 

  34. Handa N et al. A new accurate and non-invasive screening method for renovascular hypertension: the renal artery Doppler technique J Hypertens 1988; 6: S458–S460

    Article  CAS  Google Scholar 

  35. Zoller WG, Hermans H, Bogner JR, Hahn D . Middeke M. Duplex sonography in the diagnosis of renovascular hypertension Klinische Wochenschrift 1990; 68: 830–834

    Article  CAS  Google Scholar 

  36. Postma CT, Aalen van J . Boo de T, Rosenbusch G, Thien Th. Doppler ultrasound scanning in the detection of renal artery stenosis in hypertensivepatients Br J Radiol 1992; 65: 857–860

    Article  CAS  Google Scholar 

  37. Dondi M et al. Evaluation by captopril renal scintigraphy and echo-Doppler flowmetry of hypertensivepatients at high risk for renal artery stenosis J Nuclear Biol Med 1992; 36: 309–314

    CAS  Google Scholar 

  38. Spies KP et al. Color-coded duplex sonography for non-invasive diagnosis and grading of renal artery stenosis American J Hypertens 1995; 8: 1222–1231

    Article  CAS  Google Scholar 

  39. De Cobelli F et al. Renal artery stenosis: prospective comparison of color Doppler US and breath-hold, three-dimensional, dynamic, gadolinium-enhanced MR Angiography Radiology 2000; 214: 373–380

    Article  CAS  Google Scholar 

  40. Moses LE, Shapiro D, Littenberg B . Combining independent studie of a diagnostic test in a summary ROC curve: data-analytic approaches and some additional considerations Stat Med 1993; 12: 1293–1316

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Diagnostic Radiology, University Hospital, Maastricht, The Netherlands

    M W de Haan, K Flobbe & J M A van Engelshoven

  2. Department of Clinical Epidemiology and Medical Technology Assessment, University Hospital Maastricht, The Netherlands

    A G H Kessels

  3. Department of Internal Medicine, University Hospital Maastricht, The Netherlands

    A A Kroon & P W de Leeuw

  4. Department of Surgery, University Hospital Maastricht, The Netherlands

    J H Tordoir

Authors
  1. M W de Haan
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. A A Kroon
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. K Flobbe
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. A G H Kessels
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. J H Tordoir
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. J M A van Engelshoven
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. P W de Leeuw
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to M W de Haan.

Rights and permissions

Reprints and permissions

About this article

Cite this article

de Haan, M., Kroon, A., Flobbe, K. et al. Renovascular disease in patients with hypertension: detection with duplex ultrasound. J Hum Hypertens 16, 501–507 (2002). https://doi.org/10.1038/sj.jhh.1001429

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/sj.jhh.1001429

Keywords

This article is cited by

Search

Advanced search

Quick links