Images in Clinical Medicine

Captopril-Augmented Renal Scan

Atsuo Goto, M.D., and Nobuo Kawauchi, M.D.

N Engl J Med 2001; 344:430February 8, 2001

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Figure 1 A 22-year-old woman had had hypertension for one year. Her only symptom was an occasional headache. Examination revealed a blood pressure of 148/110 mm Hg, a vascular bruit on the left-hand side of the upper abdomen, and no cardiomegaly. The electrocardiogram was normal. Renal scanning with [^99mTc]pentetic acid (DTPA) showed less uptake of the tracer in the left kidney than in the right, with a similar time to peak uptake (Panel A). The patient was then given 25 mg of captopril orally, and renal scanning was repeated one hour later. The curve for the left kidney was flat (Panel B). In the presence of stenosis, captopril should abrogate the protective actions of the high levels of angiotensin II on the autoregulation of the glomerular filtration rate. The scintigraphic images also suggested the presence of stenosis of the left renal artery. Angiography (Panel C) revealed stenosis in the midportion of the left renal artery (arrowhead) and in the anterior division of the left renal artery (arrow), which was accompanied by post-stenotic dilatation. Both lesions were presumably caused by fibromuscular dysplasia. The patient's blood pressure returned to normal within three hours after percutaneous transluminal angioplasty and has remained normal for three years.

Atsuo Goto, M.D.
Nobuo Kawauchi, M.D.
University of Tokyo, Tokyo 113, Japan

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