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Captopril Renography in Two Kidney and One Kidney Goldblatt Hypertension in Dogs

Departments of Medicine, Radiology, and Surgery, Medical College of Ohio, Toledo, Ohio

Correspondence: For reprints contact: Joseph V. Nally, Jr., MD, Hypertension & Nephrology, Cleveland Clinic Foundation, 9500 Euclid Ave., Cleveland, OH 44106.

ABSTRACT

In order to improve on the technique of noninvasive detection of renal artery stenosis, we studied the effects of angiotensin converting enzyme inhibition with captopril on individual kidney hemodynamics and function as assessed by technetium-99m diethylenetriaminepentaacetic acid ([99mTc]DTPA) renal flow studies and iodine-131 orthoiodohippurate ([¹³¹I]hippuran) renography in experimental Goldblatt's hypertension. In two-kidney, one-dip (renin-dependent) hypertension, captopril (1.5 mg/kg bolus with 1.5 mg/min infusion) reduced mean arterial pressure (MAP) and ipsilateral glomerular filtration rate (GFR) without changes in the contralateral kidney. Captopril infusion resulted in alterations in both the [^99mTc]DTPA and [¹³¹I]hippuran studies, which were most evident in the 15-min [^99mTc]DTPA renal flow studies. In one-kidney, one-clip (volume-dependent) hypertension, captopril reduced MAP but did not alter GFR, renal plasma flow, or the radionuclide studies. These studies suggest that the [^99mTc]DTPA renal flow study coupled with captopril challenge may unmask intrarenal angiotensin II-dependent functional and hemodynamic changes of the stenotic kidney, and offers promise in the detection of renin-dependent hypertension.