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      Prevalence and Risk Factors of Atherosclerotic Renal Artery Stenosis in 1,200 Chinese Patients Undergoing Coronary Angiography

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          Abstract

          Aims: Atherosclerotic renal artery stenosis (ARAS) is a common and potentially reversible cause of end-stage renal failure. Our study aimed to determine the prevalence and predictors of ARAS in Chinese patients undergoing coronary angiography for suspected coronary heart disease (CAD), or for acute or chronic myocardial infarction. Methods: Selective renal arteriography was performed immediately after coronary angiography in 1,200 consecutive patients. Medical history and laboratory data were obtained before the procedure. Significant renal artery stenosis was defined as ≧50% narrowing of the luminal diameter. Uni- and multivariate logistic regression analyses were made to explore the association of the clinical and laboratory variables, including some items which had never or rarely been studied, with ARAS or CAD. Results: Of the 1,200 patients, 840 were male and 360 female. Their mean age was 62 ± 10 years. Low-grade (<50%) and significant coronary artery stenosis was found in 108 (9%) and 610 (51%) patients respectively. By multivariate logistic regression analysis, risk factors associated with the presence of coronary artery stenosis included male, older age, smoking, high serum concentration of low density lipoprotein, lipoprotein (a), and fast blood glucose ≧7.0 mmol/l. Significant ARAS was present in 116 (9.7%) patients, of which 20 (1.7%) were bilateral. The incidence of ARAS was similar in patients with suspected CAD or myocardial infarction. Multivariate logistic regression analysis showed the association of the clinical variables with ARAS included: older age, hypercholesterolemia, a more than 10-year history of hypertension, proteinuria and S<sub>Cr</sub> ≧133 µmol/l. The severity of ARAS is significantly related to the severity of coronary artery disease. Conclusion: ARAS is a frequent finding in Chinese patients undergoing coronary angiography, especially in patients with significant coronary artery stenosis and risk factors for ARAS. Renal arteriography can be a helpful examination in these patients.

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          Severity of renal vascular disease predicts mortality in patients undergoing coronary angiography.

          K Pieper, Kristen M. Little, P Conlon … (2001)
          Renal artery stenosis (RAS) is a relatively uncommon but potentially reversible cause of renal failure. In a previous report, we demonstrated that the presence of RAS is independently associated with mortality in a group of patients undergoing coronary angiography. Our current study expands on this cohort, investigating the effect of the severity of RAS on all-cause mortality. A total of 3987 patients underwent abdominal aortography immediately following coronary angiography. For the purpose of survival analysis, significant RAS was defined as > or =75% narrowing in the luminal diameter. Significant RAS was present in 4.8% of patients studied and was bilateral in 0.8%. Factors associated with the presence of RAS included female gender, older age, hypertension, congestive heart failure, elevated serum creatinine, and congestive heart failure. The four-year unadjusted survivals for patients with and without significant RAS were 57 and 89%, respectively (P or =95% stenosis was 70%, 68%, and 48%, respectively. In addition, bilateral disease was associated with four-year survival of 47% as compared with 59% for patients with unilateral disease (P < 0.001). The impact of RAS on survival remained robust regardless of the manner of treatment of coronary artery disease [that is, medical, percutaneous transluminal coronary angioplasty (PTCA), or coronary artery bypass graft (CABG)]. In this patient population, the presence of RAS is a strong independent predictor of mortality. Increasing severity of RAS has an incremental effect on survival probability.
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            Mechanisms of renal structural alterations in combined hypercholesterolemia and renal artery stenosis.

            Tatsuya Sawamura, Martin Rodriguez-Porcel, Joseph Grande … (2003)
            Atherosclerotic renovascular disease (ARVD) aggravates renal scarring more than other causes of renal artery stenosis (RAS), but the underlying pathogenic mechanisms of this potential profibrotic effect remain unclear. We tested the hypothesis that coexistence of atherosclerosis and RAS interferes with renal tissue remodeling. Single-kidney hemodynamics and function were quantified in vivo with electron-beam computed tomography in 3 groups of pigs (n=7 each): normal pigs, pigs 12 weeks after induction of unilateral RAS (RAS group), and pigs with similar-degree RAS fed a 12-week 2% hypercholesterolemic diet (HC+RAS, simulating early ARVD). Kidneys were studied ex vivo by Western blotting and immunohistochemistry. Renal volume, renal blood flow, and glomerular filtration rate were similarly decreased in RAS and HC+RAS ischemic kidneys, accompanied by similar increased expression of profibrotic factors like transforming growth factor-beta, tissue inhibitor of metalloproteinase-1, and plasminogen activator inhibitor-1. Nevertheless, HC+RAS kidneys showed increased intrarenal fibrosis compared with RAS-only kidneys. Furthermore, expression of nuclear factor-kappaB was increased, expression of extracellular (matrix metalloproteinase-2) and intracellular (ubiquitin) protein degradation systems was decreased, and apoptosis was blunted. Diet-induced HC superimposed on RAS accelerates the development of fibrosis in the stenotic kidney by amplifying profibrotic mechanisms and disrupting tissue remodeling. These alterations might contribute to renal disease progression in ARVD and might account for the increased propensity for end-stage renal disease.
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              Clinicopathological correlation in biopsy-proven atherosclerotic nephropathy: implications for renal functional outcome in atherosclerotic renovascular disease.

              I Roberts, J. Wright, Satya Kalra … (2001)
              Atherosclerotic renovascular disease (ARVD) is commonly associated with renal failure. It is now recognized that intrarenal damage, (ischaemic or atherosclerotic nephropathy) is a major contributor to the renal impairment in these patients. In this study the impact of histological changes upon renal functional outcome was investigated in patients with atherosclerotic nephropathy. The Hope Hospital renal biopsy database (1985-1998) was interrogated for patients with histology compatible with atherosclerotic nephropathy. Case-note review enabled the assessment of several clinical parameters and outcomes, including change in creatinine clearance per year (DeltaCrCl (ml/min/year)), blood pressure control, dialysis need, and death. Renal parenchymal damage was analysed by morphometric analysis (of interstitial fibrosis and glomerulosclerosis) and a semi-quantitative chronic damage score (score 0-3 (normal-severe) for each of glomerulosclerosis, interstitial fibrosis, tubular atrophy, and arteriolar hyalinosis; maximum=12). Patients were stratified into two groups who had either deteriorating (group 1) or stable (group 2) renal function during follow-up. Twenty-five patients (age 64.7+/-10.5, range 43-83 years; 17 male, eight female) were identified. Sixteen patients had undergone angiography; two had significant (>50%) renal artery stenosis. Mean follow-up was 25.6+/-14.8 (range 5-50) months. Group 1 patients had DeltaCrCl -7.4+/-6.8 ml/min/year, n=14 and group 2 patients had DeltaCrCl 4.8+/-7.0 ml/min/year, n=11. Four patients in group 1 developed end-stage renal disease and five patients died (three in group 1 and two in group 2). At study entry, group 1 patients had worse renal function (CrCl 27.6+/-17.6 vs 36.0+/-33.9, NS), greater proteinuria (1.2 vs 0.5 g/24 h, NS), and higher systolic blood pressure (167.1+/-30.8 mmHg vs 150.6+/-37.8, NS) compared with group 2 patients. Group 1 patients showed more glomerulosclerosis (51.6 vs 24.9%, P:<0.01), greater proportional interstitial volume (44.9 vs 33.9%, P:<0.02), and higher overall chronic damage score (P:<0.05) than those in group 2. There was a significant correlation between renal functional outcome and chronic damage score, glomerulosclerosis and proportional interstitial volume for the entire patient cohort. In patients with atherosclerotic nephropathy the severity of histopathological damage is an important determinant and predictor of renal functional outcome.
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                Author and article information

                Journal
                Journal ID (publisher-id): NEC
                Journal ID (nlm-ta): Nephron Clin Pract
                Journal ID (doi): 10.1159/issn.1660-2110
                Title: Nephron Clinical Practice
                Publisher: S. Karger AG
                ISSN (Electronic): 1660-2110
                Publication date Subscription-year: 2006
                Publication date (Print): November 2006
                Publication date (Electronic): 25 September 2006
                Volume: 104
                Issue: 4
                Pages: c185-c192
                Affiliations
                Departments of aCardiology and bNephrology, Zhongshan Hospital, Fudan University, Shanghai, China
                Article
                Publisher ID: 95854 Other ID: Nephron Clin Pract 2006;104:c185–c192
                DOI: 10.1159/000095854
                PubMed ID: 17003570
                SO-VID: 17c173fa-d1c8-41d7-ae28-5682a5959ec7
                Copyright © © 2006 S. Karger AG, Basel
                License:

                Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

                History
                Date received : 02 November 2005
                Date accepted : 19 June 2006
                Page count
                Tables: 5, References: 18, Pages: 1
                Categories
                Subject: Original Paper

                ScienceOpen disciplines: Cardiovascular Medicine,Nephrology
                Keywords: Coronary artery angiography,ARAS, prevalence,Atherosclerotic renal artery stenosis,ARAS, risk factors
                Data availability:
                ScienceOpen disciplines: Cardiovascular Medicine, Nephrology
                Keywords: Coronary artery angiography, ARAS, prevalence, Atherosclerotic renal artery stenosis, ARAS, risk factors

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