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NDT Advance Access originally published online on December 15, 2006
Nephrology Dialysis Transplantation 2007 22(3):689-692; doi:10.1093/ndt/gfl673
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© The Author [2006]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Poor performance of diagnostic tests for atherosclerotic renal artery stenosis—discrepancies between stenosis and renal function

Thomas Klaas Alphons Wierema, Abraham Anthonie Kroon and Peter Wilhelmus de Leeuw

Department of Medicine, University Hospital Maastricht and Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands

Correspondence and offprint requests to: Peter W. de Leeuw, MD, PhD, FAHA, Department of Medicine, University Hospital Maastricht, PO Box 5800, 6202 AZ Maastricht, The Netherlands. Email: p.deleeuw@intmed.unimaas.nl

Keywords: hypertension; renal artery stenosis; screening

The first 150 words of the full text of this article appear below.



   Introduction
 
Both from a pathophysiological point of view and from a clinical standpoint, atherosclerotic renal artery stenosis (RAS) remains an enigmatic disorder. With its capricious clinical presentations, it is often overlooked and diagnosed only at a very late stage. To a certain degree, the latter may be attributable to a lack of enthusiasm amongst clinicians to search for RAS. The basis for this nihilistic attitude mainly lies in the failure of several prospective studies to show a large enough benefit of surgery or angioplasty (with or without stent placement) on blood pressure and renal function. Surely, exposing a patient to diagnostic tests can be justified only when the outcome of these tests are relevant for further clinical decision making. In the case of RAS, however, the situation is a bit more complicated than outcome trials would have us believe. Indeed, even though the effect of balloon angioplasty may be relatively small . . . [Full Text of this Article]



   When should we think of renal artery stenosis?
 


   What do screening tests teach us?
 


   Our faulty concept of symmetry
 


   The fallacy of clinically significant stenosis
 


   Where should we go from here?
 

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