Prevalence of Renal Artery Stenosis Following Diagnostic Coronary Angiography

Document Type : Research Paper

Authors

1 Assistant Professor of cardiology, EmamReza hospital, Mashhad University of Medical Sciences; Mashhad, Iran

2 Associate professor of cardiology, EmamReza hospital, Mashhad University of Medical Sciences, Mashhad, Iran

Abstract

Introduction
Renal artery atherosclerosis is the most common cause of renovascular hypertension and ischemic nephropathy which is potentially a correctable problem by surgery or intravascular intervention. The prevalence of Renal Artery Disease (RAD) in hypertensive patients evaluated for Coronary Artery Disease (CAD) as the main symptom of atherosclerosis, in our population is unknown, we began evaluation of renal artery stenosis in these patients.
Materials and Methods
A prospective cross-sectional study carried out from March 2004 through January 2005 in cardiology department of Emam Reza Hospital, Mashhed University of Medical Sciences, Mashhad, Iran. Over all 255 of patients suspicious of CAD included in this study. Coronary angiography performed by femoral artery approach followed by renal artery angiography. Artery' involvement with more than 50% of the lumen (renal arteries or coronaries) classified as significant stenosis. Coronary stenosis divided into 1-, 2- or 3-vessel involvement. Collected data analyzed by SPSS.
Results
The patients were 129 males and 126 females, with the mean age of 58.5%+10.6. A total of 200 patients (mean age of 59.7±10.5) had CAD and the reminders had normal coronary arteries (mean age 61.5±10.3). The Prevalence of RAD in patients with CAD was 31% (63 patients; 19 bilateral and 44 unilateral stenosis), of significant RAD in 1-, 2-, or 3-vessel involvement were as follow respectively 24.27%, 35.7% and 36.5 %. In 55 patients with normal coronary arteries, the prevalence of RAD was 3.6% (p<0.001).
Conclusion
Many studies have shown the progressive nature of renal artery stenosis; therefore, early diagnosis will prevent its progression and other consequences. Our results suggest that CAD, especially when more arteries are involved, is a predictor of renal artery stenosis. Since 31% of our hypertensive patients with CAD had significant renal artery stenosis, we recommend that renal artery angiography be performed following coronary angiography for those patients with significant stenosis.

Keywords

References

1- Zoccali C,Mallamaci F,Finocchiaro P.Atherosclerotic Renal artery Stenosis: Epidemiology,Cardiovascular
Outcomes, and Clinical Prediction Rules.J Am Soc Nephrol 2002;13: 5179–5183.
2- Caps MT, Perissinotto C, Zierler RE, Polissar NL, Bergelin RO, Tullis MJ, et al. Prospective study of
atheroscleroticdisease progression in the renal artery. Circulation 1998; 98:2866-5872.
3- Jacobson HR. Ischemic renal disease: an overlooked clinical entity?.Kidney Int 1988; 34:729–743.
4- Scoble JE, Hamilton G. Atherosclerotic renovascular disease. Remediablecause for renal failure in the elderly. Br
Med J 1990; 300:1670–1673.
5- Sawicki PT, Kaiser S, Heinemann I, Frenzel H, Berger M. Prevalenceof renal artery stenosis in diabetes mellitusan
autopsy study. Ann Intern Med 1991;229:489-492.
6- Tollefson DF, Ernst CB. Natural history of atherosclerotic renal arterystenosis associated with aortic disease. J
Vasc Surg 1991;14:327-331.
7- Crowley JJ, Santos RM, Peter RH, Puma JA, Schwab SJ, Phillips HR, et al. Progression of renal artery stenosisin
patients undergoing cardiac catheterization. Am Heart J 1998; 136:913-918.
8- Caps MT, Zierler RE, Polissar NL, Bergelin RO, Beach KW, Cantwell-Gab K, et al. Risk of atrophy in kidneys
with atherosclerotic renal artery stenosis. Kidney Int 1998; 53:735-742.
9- Robert d. Safi an, Stephen c. Textor. Renal artery stenosis. N Engl J Med 2001; 8???
10- Hirsch AT, Haskal ZJ, Hertzer NR, Bakal CW, Creager MA, Halperin JL, et al . ACC /AHA 2005 practice
Guidelines for the management of patients with peripheral arterial disease (Lower extremity , renal , mesenteric ,
and abdominal aortic): Executive summary .J AM Coll Cardiol 2006; 47:1239-1312.
11- Leertouwer TC, Pattynama PM, Van den Berg-Huysmans A. Incidental renal artery stenosis in peripheral
vascular disease: a case for treatment ?. Kidney Int 2001; 59:1480-1483.
12- Eduardo Infante de Oliveira?/ ,Christopher Bajzer. Renal Artery Stenosis. In: Eric J Topol. Textbook of
Interventional Cardioligy. 5th ed. Saunders Elsevier; 2008.p. 763-776.
13- Roubidoux MA , Dunnick NR, Klotman PE, Newman GE, Cohan RH, Kadir S, et al. .Renal vein renins :
inability to predict response to revascularization in renins : inability to predict response to revascularization in
patients with hypertension . Radiology 1991; 178:819-822.
14- Cheung CM, shurrab AE, Buckley DL, Hegarty J, Middleton RJ, Mamtora H, et al . MR – derived renal
morphology and renal function in patients with atherosclerotic renovascular disease . Kidney Int 2006; 69:715-722.
15- Buller CE, Nogareda JG, Ramanathan K, Ricci DR, Djurdjev O, Tinckam KJ, et al. The profile of cardiac
patients with renal artery stenosis .J Am Coll Cardiol 2004;9: 1606-1613.
16- Song HY, Hwang JH, Noh H, Shin SK, Choi DH, Shim WH, Lee HY , et al. The Prevalence and associated risk
factors of renal artery Ssenosis in ptients undergoing cardiac catheterization. Yonsei Med J 2000; 41:219-225.
17- Leandri M, Lipiecki J, Lipiecka E, Hamzaoui A, Amonchot A, Mansour M, et al. Prevalence of renal artery
stenosis in patients undergoing cardiac catheterization: when should abdominal aortography be performed? Results
in 467 patients. J Radial 2004; 85: 627-33.
18- Rihal CS, Textor SC, Breen JF, McKusick MA, Grill DE, Hallett JW, et al. Incidental renal artery stenosis
among a prospective cohort of hypertensive patients undergoing coronary angiography. Mayo Clin Proc 2002; 77:
309-316.
19- Conlon PJ, Little MA, Pieper K, Mark DB. Severity of renal vascular disease predicts mortality in patients
undergoing coronary angiography.Kidney Int 2001; 60:1490 –1497.
20- Adeera Levin Stuart Linas Friedrich C. Luft Arlene B. Chapman Stephen Textor. Controversies in Renal Artery
Stenosis: A Review by the American Society of Nephrology Advisory Group on Hypertension. Am J Nephrol 2007;
27:212–220.
21- Van Ampting JM, Penne EL, Beek FJ, Koomans HA, Boer WH, Beutler JJ. .Prevalence of atherosclerotic renal
artery stenosis in patients starting dialysis. Nephrol Dial Transplant 2003;18:1147-1151.
22- Bates MC, Campbell JE, Broce M, Lavigne PS, Riley MA.Serum Creatinine Stabilization Following Renal
Artery Stenting.Vasc Endovascular Surg 2008; 42: 40 – 46.
medical journal of mashhad university of medical sciences
Volume 51, Issue 4 - Serial Number 4
November and December 2008
Pages 215-218

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