Atherosclerotic ischemic renal disease. Diagnosis and prevalence in an hypertensive and/or uremic elderly population

BMC Nephrology

Rosario Cianci³  Alvaro Zaccaria²  Michele Ferrannini⁵  Daniela Sardella⁵  Guido Ventroni⁶  Michele Rossi⁴  Giuseppe Ronga⁶  Italo Nofroni¹  Eleonora Moscaritolo⁵  Silvia Lai³  Santo Calabria⁵  Giorgio Coen⁵ 

[1] Dep. Experimental Medicine and Pathology, First Medical Faculty, La Sapienza University, Rome, Italy;Dept of Vascular Surgery, First Medical Faculty, La Sapienza University, Rome, Italy;6th Medical Clinic, First Medical Faculty, La Sapienza University, Rome, Italy;Dept of Radiology, First Medical Faculty, La Sapienza University, Rome, Italy;Renal Pathophysiology and Hypertension Unit, Second Medical Faculty, La Sapienza University, Rome, Italy;Nuclear Medicine Unit, First Medical Faculty, La Sapienza University, Rome, Italy

关键词: magnetic resonance angiography;    isotopic renography;    doppler ultrasonography;    chronic renal failure;    atherosclerosis;    renal artery stenosis;   

Others  :  1083455
DOI  :  10.1186/1471-2369-4-2

 received in 2002-08-21, accepted in 2003-02-06,  发布年份 2003

【 摘 要 】

Background

Atherosclerotic ischemic renal disease is a frequent cause of end-stage renal failure leading to dialysis among the elderly; Its prevalence is inferred from autopsy or retrospective arteriographic studies. This study has been conducted on 269 subjects over 50 with hypertension and/or CRF, unrelated to other known causes of renal disease.

Methods

All 269 patients were studied either by color-flow duplex sonography (n = 238) or by renal scintigraphy (n = 224), and 199 of the 269 patients were evaluated using both of these techniques. 40 patients, found to have renal artery stenosis (RAS), were subjected to 3D-contrast enhancement Magnetic Resonance Angiography (MRA) and/or Selective Angiography (SA). An additional 23 cases, negative both to scintigraphy and to ultrasound study, underwent renal angiography (MRA and/or SA).

Results

Color-duplex sonography, carried out in 238 patients, revealed 49 cases of RAS. MR or SA was carried out in 35 of these 49 patients, and confirmed the diagnosis in 33. Color-duplex sonography showed a PPV value of 94.3% and NPV of 87.0% while renal scintigraphy, carried out in 224 patients, had a PPV of 72.2% and a NPV of 29.4%. Patients with RAS showed a higher degree of renal insufficiency compared to non stenotic patients while there were no differences in proteinuria. RAS, based on color-duplex sonography studies, was present in 11% of patients in the age group 50–59, 18% in the 60–69 and 23% at age 70 and above.

Conclusions

A relatively large percentage of the elderly population with renal insufficiency and/or hypertension is affected by RAS and is at risk of developing end-stage renal failure. Color-duplex ultrasonography is a valid routine method of investigation of population at risk for renal artery stenosis.

【 授权许可】

   
2003 Coen et al; licensee BioMed Central Ltd. This is an Open Access article: verbatim copying and redistribution of this article are permitted in all media for any purpose, provided this notice is preserved along with the article's original URL.

【 参考文献 】

• [1]Dean RH, Tribble RW, Hansen KJ, O'Neil EA, Craven TE, Redding JF: Evolution of renal insufficiency in ischemic nephropathy. Ann Surg 1991, 213:446-456.
• [2]Hansen JK: Prevalence of ischemic nephropathy in the atherosclerotic population. Am J Kidney Dis 1994, 24:615-621.
• [3]Meyrier A, Buchet P, Simon P, Fernet M, Rainfray M, Callard P: Atheromatous renal disease. Am J Med 1988, 85:139-146.
• [4]Greco BA, Breyer JA: Atherosclerotic ischemic renal disease. Am J Kidney Dis 1997, 29:167-187.
• [5]Coen G, Manni M, Giannoni MF, Bianchini G, Calabria S, Mantella D, et al.: Ischemic nephropathy in elderly nephrologic and hypertensive population. Am J Nephrol 1998, 18:221-227.
• [6]USRDS 1994 Annual Data Report: executive summary. Am J Kidney Dis 1994, 24:s12-17.
• [7]Appel RG, Bleyer AJ, Reavis S, Hansen KJ: Renovascular disease in older patients beginning renal replacement theraphy. Kidney Int 1995, 48:171-76.
• [8]Holley KE, Hunt JK, Brown AL, Kinkaid OW, Sheps SG: Renal artery stenosis. A clinical-pathologic study in normotensive and hypertensive patients. Am J Med 1964, 37:14-22.
• [9]Sawicki PT, Kaiser S, Heinemann L, Frenzel H, Berger M: Prevalence of renal artery stenosis in diabetes mellitus-an autopsy study. J Intern Med 1991, 229:489-92.
• [10]Eyler WR, Clark MD, Garman JE, Rian RL, Meininger DE: Angiography of the renal areas including a comparative study of renal arterial stenoses in patients with and without hypertension. Radiology 1962, 78:879-92.
• [11]Valentine RJ, Clagett GP, Miller GL, Martin JD, Chervu A: The coronary risk of unsuspected renal artery stenosis. J Vasc Surg 1993, 18:433-440.
• [12]Olin JW, Piedmonte MR, Young JR, De Anna S, Grubb M, Childs MB: The utility of duplex ultrasound scanning of the renal arteries for diagnosing significant renal artery stenosis. Ann Intern Med 1995, 122:833-36.
• [13]Oei HY, Geyskes GG, Dorhout Mess EJ, Puylaert CB: The significance of captopril renography in renovascular hypertension. Contrib Nephrol 1987, 56:95-103.
• [14]Taylor AT Jr, Fletcher JW, Nally JV Jr, Blaufox MD, Dubovsky EV, Fine EJ, et al.: Procedure guideline for diagnosis of renovascular hypertension. Society of Nuclear Medicine. J Nucl Med 1998, 39:1297-302.
• [15]Ghantous VE, Eisen TD, Sherman AH, Finkelstein FO: Evaluating patients with renal failure for renal artery stenosis with gadolinium-enhanced magnetic resonance angiography. Am J Kid Dis 1999, 33:36-42.
• [16]Schoenberg SO, Knopp MV, Prince MR, Allenberg JR: Combined morphologic and functional assessment of renal artery stenosis using gadolinium enhanced magnetic resonance imaging. Nephrol Dial Transplant 1998, 13:2738-2742.
• [17]Gilfeather M, Yoon HC, Siegelman ES, Axel L, Stolpen AH, Shlansky-Goldberg RD, et al.: Renal artery stenosis: evaluation with conventional angiography versus gadolinium-enhanced MR angiography. Radiology 1999, 210:367-372.
• [18]De Cobelli F, Vanzulli A, Sironi S, Mellone R, Angeli E, Venturini M, et al.: Renal artery stenosis: evaluation with breath-hold, three-dimensional, dinamic, gadolinium-enhanced versus three-dimensional, phase-contrast MR angiography. Radiology 1997, 205:689-695.
• [19]Scoble JE: Nuclear medicine imaging in renovascular diasease: the nephrologist's view. Nucl Med Commun 1997, 18:503-504.
• [20]Suresh M, Laboi P, Martora H, Kalra PA: Relationship of renal dysfunction to proximal arterial disease severity in atherosclerotic renovascular disease. Nephrol Dial Transplant 2000, 15:631-636.
• [21]Boero R, Degli Espositi E, Galli G, Lo sito A, Mambelli E, Stella I, et al.: Linee Guida per la nefropatia ischemica arteriosclerotica. Giornale Italiano di Nefrologia. 1999, 6(Suppl):14-22.
• [22]Jacobson HR: Ischemic renal disease: an overlooked entity? Kidney Int 1988, 34:729-743.
• [23]Makanjuola AD, Suresh M, Laboi P, Kalra PA, Scoble JE: Proteinuria in atherosclerotic renovascular disease. QJM 1999, 92:515-518.
• [24]Makanjuola AD, Scoble JE: Ischemic nephropathy – is the diagnosis excluded by heavy proteinuria? Nephrol Dial transplant 1999, 14:2795-2797.
• [25]Greenberg A, Bastacky SI, Iqbal A, Borochovitz D, Johnson JP: Focal segmental glomerulosclerosis associated with nephrotic sindrome in cholesterol atheroembolism: clinicopathological correlations. Am J Kidney Dis 1997, 29:334-344.
• [26]Alkhunaizi A, Chapman A: Renal artery stenosis and unilateral focal and segmental glomerulosclerosis. Am J Kidney Dis 1997, 29:936-941.
• [27]Thadhani R, Pascual M, Nickeleit V, Tolkoff-Rubin N, Colvin R: Preliminary description of focal segmental glomerulosclerosis in patients with renovascular disease. Lancet 1996, 347:231-233.