Renal artery stenosis: ultrasound could help diagnose it

Clinical bottom line (level )

  1. Two-thirds of patients with suspected renovascular disease had it.
  2. Doppler ultrasound could help diagnose renal artery stenosis (LR + 62) and make it less likely (LR - 0.016) .
Olin et al: Ann Intern Med 1995; 122 : 833-838
Expires January 2000

The study

Setting: university hospital, USA

102 patients (aged mean 63, 57% female) with difficult to control hypertension, unexplained azotemia or associated peripheral vascular disease

Excluded if
  • received only ultrasonography or arteriography and not both


Independent blinded reference standard, applied in all patients from a consecutive inappropriate spectrum.
Reference standard:
  • renal arteriography: renal artery stenosis diagnosed if > 60% stenosis
Diagnostic test: duplex ultrasound scanning

The evidence

pre-test probability of renal artery stenosis: 66%, (95% CI: 60% to 73%)

diagnostic test renal artery stenosis no renal artery stenosis LR+
(95% CI)		 post-test probability LR-
(95% CI)		 post-test probability
ultrasound scan 122 1 62
(8.9 to 430) 		99% 0.016
(0.0041 to 0.0648) 		3%
total 124 63

Comments

  1. Results are reported for individual renal arteries and not for patients.

Citation

  1. Olin JW, Piedmonte MR, Young JR, et al: the utility of duplex ultrasound scanning of the renal arteries for diagnosing significant renal artery stenosis. Ann Intern Med 1995; 122 : 833-838
Search Terms: from reference list of systematic review
Contributor: , January 1999
Reviewer:

Clinical Question.
Patient suspected renovascular disease
Intervention or Exposure duplex ultrasound
Comparison renal arteriography
Outcome renal artery stenosis