CLINICAL RESEARCH: PERIPHERAL VASCULAR DISEASE
The profile of cardiac patients with renal artery stenosis
Christopher E. Buller, MD, FACC*,*,
Jorge G. Nogareda, MD*,
Krishnan Ramanathan, MD*,
Donald R. Ricci, MD, FACC*,
Ognjenka Djurdjev, MSc ,
Kathryn J. Tinckam, MD ,
Ian M. Penn, MD, FACC*,
Rebecca S. Fox, MSc ,
Lesley A. Stevens, MD,
John A. Duncan, MD and
Adeera Levin, MD
* Cardiology, University of British Columbia, Vancouver, Canada
Nephrology, University of British Columbia, Vancouver, Canada
Centre for Health Evaluation and Outcome Sciences, Vancouver, Canada
Vancouver Hospital, Vancouver, Canada
Manuscript received June 27, 2003;
revised manuscript received November 7, 2003,
accepted November 13, 2003.
* Reprint requests and correspondence: Dr. Christopher E. Buller, The Sauder Family Heart and Stroke Foundation, Chair in Cardiology, Head–Division of Cardiology, University of British Columbia, St. Paul's Hospital, 1081 Burrard Street, Vancouver, B.C., Canada V6Z 1Y6.
cbuller{at}providencehealth.bc.ca
OBJECTIVES: 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.
BACKGROUND: The diagnosis of atherosclerotic RAS remains problematic because its clinical manifestations are nonspecific.
METHODS: 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.
RESULTS: 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  50% in 120 (14.3%) and severe stenosis (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.
CONCLUSIONS: 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.
|
Abbreviations and Acronyms
| | BP | = blood pressure | | CAD | = coronary artery disease | | CrCl | = creatinine clearance | | GFR | = glomerular filtration rate | | LV | = left ventricular | | PRKD | = procedure-related kidney dysfunction | | RAS | = renal artery stenosis |
|
This article has been cited by other articles:
|
|
|
|
 
E. Mahmud, T. W.R. Smith, V. Palakodeti, O. Zaidi, L. Ang, C. R. Mitchell, N. Zafar, G. Bromberg-Marin, S. Keramati, and S. Tsimikas
Renal Frame Count and Renal Blush Grade: Quantitative Measures That Predict the Success of Renal Stenting in Hypertensive Patients With Renal Artery Stenosis
J. Am. Coll. Cardiol. Intv.,
June 1, 2008;
1(3):
286 - 292.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
E. Mahmud, J. J. Cavendish, and A. Salami
Current Treatment of Peripheral Arterial Disease: Role of Percutaneous Interventional Therapies
J. Am. Coll. Cardiol.,
August 7, 2007;
50(6):
473 - 490.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. P. Androes, E. M. Langan III, C. A. Kalbaugh, D. W. Blackhurst, S. M. Taylor, and J. R. Youkey
Is Incidental Renal Arteriography Justified in a Population of Patients with Symptomatic Peripheral Arterial Disease?
Vascular and Endovascular Surgery,
April 1, 2007;
41(2):
106 - 110.
[Abstract]
[PDF]
|
|
|
|
|
|
|
B. De Bruyne, G. Manoharan, N. H.J. Pijls, K. Verhamme, J. Madaric, J. Bartunek, M. Vanderheyden, and G. R. Heyndrickx
Assessment of Renal Artery Stenosis Severity by Pressure Gradient Measurements
J. Am. Coll. Cardiol.,
November 7, 2006;
48(9):
1851 - 1855.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. Chonchol and S. Linas
Diagnosis and Management of Ischemic Nephropathy
Clin. J. Am. Soc. Nephrol.,
March 1, 2006;
1(2):
172 - 181.
[Full Text]
[PDF]
|
|
|
|
|
|
|
G. Manoharan, N. H.J. Pijls, N. Lameire, K. Verhamme, G. R. Heyndrickx, E. Barbato, W. Wijns, J. Madaric, X. Tielbeele, J. Bartunek, et al.
Assessment of Renal Flow and Flow Reserve in Humans
J. Am. Coll. Cardiol.,
February 7, 2006;
47(3):
620 - 625.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
E. Mahmud
Renal Artery Stenting: Is it Ready for Primetime?
J. Am. Coll. Cardiol.,
September 6, 2005;
46(5):
784 - 786.
[Full Text]
[PDF]
|
|
|
|
|
|
|
R. de Silva, N. P. Nikitin, S. Bhandari, A. Nicholson, A. L. Clark, and J. G.F. Cleland
Atherosclerotic renovascular disease in chronic heart failure: should we intervene?
Eur. Heart J.,
August 2, 2005;
26(16):
1596 - 1605.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
