The diagnosis of renovascular hypertension. A clinician's viewpoint.

The sensitivity and specificity of screening and diagnostic studies for renovascular hypertension has been the focus of debate and disappointment for many years. The use of these studies has been further restricted by the insistence of clinicians that studies provide visual identification of the anatomy of the renal vasculature. Digital subtraction angiography continues to provide an increasingly attractive alternative offering visualization of the renal arteries. Reevaluation of screening and diagnostic studies is needed to determine their potential value, particularly in patients with atherosclerotic renovascular disease and renal insufficiency and in assessing the potential salvability of the ischemic kidney.