Current status of renal angiography.

It is apparent that while indications for renal angiography remain, they have significantly decreased and changed over the years, with angiography having largely been replaced by other imaging modalities. It is perhaps indicative of the current role of renal angiography that at the 1985 courses and meetings of both the Society of Cardiovascular Radiology and the Society of Uroradiology there was virtually no discussion of this modality except as applied to the study and therapy of renovascular hypertension. Angiography is no longer the only and frequently not the best method of establishing the need for renal tumor surgery; however, it may prove indispensable in planning that surgery. It is no longer felt to be productive to use angiography in the differential diagnosis of chronic renal disease and renal failure or in the investigation of renal transplant rejection other than that related to anastomotic problems, despite the fact that the angiographic findings in these conditions have been well described. Magnetic resonance imaging shows early promise in this area of diagnosis. When angiography is performed, it is more often than not as a preliminary to an interventional, catheter-mediated procedure, rather than for a purely diagnostic purpose. As the efficient utilization of medical resources becomes of greater concern, the selection of the procedure most likely to be definitive from among the many imaging possibilities available in the genitourinary tract becomes a major responsibility of the treating physician and the radiologist in consultation. Both must be willing to adopt new and more efficient techniques as they become established, retaining older modalities in those situations in which the latter maintain superiority, at all times avoiding needless multiplicity of examinations.