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      Renal Artery Stenosis and Its Predictors in Hypertensive Patients Undergoing Coronary Artery Angiography

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          Abstract

          Background

          Renal artery stenosis (RAS) has been increasingly recognized in the recent years, especially in patients with coronary artery disease (CAD). RAS affects the patients with hypertension (HTN), but the exact prevalence is not known.

          Objectives

          This study was performed to determine the prevalence and to identify the predictors of RAS in hypertensive patients undergoing coronary artery angiography.

          Patients and Methods

          In a cross-sectional study from August 2008 to August 2009, 481 patients with HTN and suspected CAD underwent selective coronary and renal angiography for screening and predicting RAS. RAS was defined as a higher than 50% stenosis in the renal artery lumen. Multivariate analysis of factors associated with the presence of RAS were examined using a logistic regression model.

          Results

          The mean ± standard deviation of age was 59.25 ± 10.81 years and 50.3% were men. According to angiographic data, 425 patients (88.4%) had CAD, while 56 (11.6%) had normal coronary arteries. RAS was seen in 94 (22%) patients with CAD. The multivariate logistic regression analysis identified only age (P < 0.001) and the number of significant coronary lesions (P < 0.001) as independent predictors of RAS. Gender, smoking, congestive heart failure, diabetes mellitus (DM), hyperlipidemia (HLP) and body mass index (BMI) were not independent predictors.

          Conclusions

          This study suggests that in the management of patients with RAS, risk factors should most likely be considered as beneficial. In addition, the clinical and angiographic features are helpful in predicting its presence in elderly patients with CAD.

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          Most cited references30

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          Coronary anatomy predicts presence or absence of renal artery stenosis. A prospective study in patients undergoing cardiac catheterization for suspected coronary artery disease.

          This study aimed to determine the prevalence of renal artery stenosis (RAS) and associated risk factors in patients undergoing cardiac catheterization for suspected coronary artery disease (CAD). One hundred and seventy-seven consecutive patients (62 females) with a serum creatinine concentration or=50%) were detected, 12 of whom had high grade (>or=70%) RAS, and two subjects had significant RAS without CAD. Patients with RAS were older (67+/-8 vs 61+/-11 years, mean+/-SD;P =0.004), had higher systolic blood pressure (150+/-15 vs 138+/-20 mmHg;P =0.005), a lower glomerular filtration rate (GFR; 61+/-16 vs 80+/-22 ml.min(-1), P 2 significant coronary lesions predicted RAS (sensitivity 0.84, specificity 0.77, positive predictive value 0.30, negative predictive value 0.98). Screening for RAS in patients with >2 diseased coronary segments has a high diagnostic yield, which is even greater in the presence of a reduced GFR, diabetes mellitus, and elevated systolic blood pressure.
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            The profile of cardiac patients with renal artery stenosis.

            We examined the prevalence and severity of renal artery stenosis (RAS) in patients undergoing cardiac catheterization who were deemed at risk for RAS based on clinical or laboratory criteria for study entry, but who had not previously been suspected of having RAS. The diagnosis of atherosclerotic RAS remains problematic because its clinical manifestations are nonspecific. Consecutive patients undergoing non-emergent cardiac catheterization at a single institution during a 12-month period were evaluated using standardized clinical, laboratory, and angiographic criteria. Patients exhibiting at least one of four predefined selection criteria (severe hypertension, unexplained renal dysfunction, acute pulmonary edema with hypertension, or severe atherosclerosis) were prospectively registered and underwent coincident diagnostic renal angiography. Renal angiography was performed in 851 patients and was diagnostic in 837. Angiographically evident renal atherosclerosis was present in 39% of the population, with RAS > or =50% in 120 (14.3%) and severe stenosis (> or =70%) in 61 (7.3%). Severe stenosis was present in 48 (7%) patients with severe atherosclerosis, 38 (16%) with renal dysfunction, 25 (9%) with hypertension, and 2 (22%) with acute pulmonary edema with hypertension. The prevalence was higher in those exhibiting multiple selection criteria. In a multivariate model, severe RAS was associated with age, female gender, reduced creatinine clearance, increased systolic blood pressure, and peripheral or carotid artery disease. In a population at risk of, but not previously suspected of having RAS, severe RAS is associated with simple and readily determined clinical and laboratory patient characteristics. These data facilitate focused application of diagnostic renal angiography.
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              Effectiveness of management strategies for renal artery stenosis: a systematic review.

              Atherosclerotic renal artery stenosis is increasingly common in an aging population. Therapeutic options include medical treatment only or revascularization procedures. To compare the effects of medical treatment and revascularization on clinically important outcomes in adults with atherosclerotic renal artery stenosis. The MEDLINE database (inception to 6 September 2005) and selected reference lists were searched for English-language articles. The authors selected prospective studies of renal artery revascularization or medical treatment of patients with atherosclerotic renal artery stenosis that reported mortality rates, kidney function, blood pressure, cardiovascular events, or adverse events at 6 months or later after study entry. A standardized protocol with predefined criteria was used to extract details on study design, interventions, outcomes, study quality, and applicability. The overall body of evidence was then graded as robust, acceptable, or weak. No study directly compared aggressive medical therapy with angioplasty and stent placement. Two randomized trials compared angioplasty without stent and medical treatments. Eight other comparative studies and 46 cohort studies met criteria for analysis. Studies generally had poor methodologic quality and limited applicability to current practice. Overall, there was no robust evidence. Weak evidence suggested no large differences in mortality rates or cardiovascular events between medical and revascularization treatments. Acceptable evidence suggested similar kidney-related outcomes but better blood pressure outcomes with angioplasty, particularly in patients with bilateral disease. Improvements in kidney function and cure of hypertension were reported among some patients only in cohort studies of angioplasty. Available evidence did not adequately assess adverse events or baseline characteristics that could predict which intervention would result in better outcomes. The evidence from direct comparisons of interventions is sparse and inadequate to draw robust conclusions. Available evidence does not clearly support one treatment approach over another for atherosclerotic renal artery stenosis.
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                Author and article information

                Journal
                Iran J Radiol
                Iran J Radiol
                Kowsar
                Iranian Journal of Radiology
                Kowsar
                1735-1065
                2008-2711
                December 2011
                25 December 2011
                : 8
                : 4
                : 235-240
                Affiliations
                [1 ]Faculty of Nursing and Midwifery, Bushehr University of Medical Sciences, Bushehr, Iran
                [2 ]Department of Cardiology, Faculty of Medicine, Bushehr University of Medical Sciences, Bushehr, Iran
                [3 ]The Persian Gulf Tropical and Infectious Disease Research Center, Bushehr University of Medical Sciences, Bushehr, Iran
                [4 ]Department of Immunology and Allergy, Medical College, Bushehr University of Medical Sciences, Bushehr, Iran
                [5 ]The Persian Gulf Biomedical Research Institute, Bushehr University of Medical Sciences, Bushehr, Iran
                [6 ]The Persian Gulf Nuclear Medicine Research Centre, Bushehr University of Medical Sciences, Bushehr, Iran
                [7 ]Department of Community Medicine, Faculty of Medicine, Bushehr University of Medical Sciences, Bushehr, Iran
                [8 ]Department of Radiology, Fatemeh Zahra Hospital, Bushehr University of Medical Sciences, Bushehr, Iran
                Author notes
                [* ]Corresponding author: Maryam Ravanipour, Faculty of Nursing and Midwifery, Bushehr University of Medical Sciences, Bushehr, Iran. Tel.: +98-7714550187, Fax: +98-7714550187, E-mail: ravanipour@ 123456gmail.com
                Article
                10.5812/iranjradiol.4553
                3522365
                23329947
                3f926e37-6dd2-4065-a1bb-64b7447cd086
                Copyright © 2011, Tehran University of Medical Sciences and Iranian Society of Radiology

                This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 10 October 2010
                : 20 September 2011
                : 13 September 2011
                Categories
                Vascular & Interventional Radiology

                Radiology & Imaging
                coronary artery disease,hypertension,renal artery obstruction,angiography
                Radiology & Imaging
                coronary artery disease, hypertension, renal artery obstruction, angiography

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