Screening for Renovascular Hypertension-Reply

In Reply.— We agree with Drs Bush and Kidd thatbilateralrenal artery stenoses are found in approximately 25% of all cases of renovascular hypertension. The largest published series of patients, the Cooperative Study of Renovascular Hypertension, found bilateral renovascular disease in 28% (250 patients) of their patients with renal artery stenosis.1However, many renal artery lesions are functionally insignificant, since unilateral repair often cures or improves hypertension in patients with bilateral stenoses. For example, Schwarten et al2noted that while 14 of their patients had bilateral renal artery stenosis, nine of these patients responded to only unilateral angioplasty. Furthermore, the Cooperative Study of Renovascular Hypertension noted that in patients with bilateral disease who responded to surgery, 83.3% had abnormal rapid-sequence IVPs. Thus, while the sensitivity of the rapid-sequence IVP is lower in detecting bilateral renal artery stenosis, it remains a useful means of uncovering functionally significant renal vascular