Abstract
Atherosclerotic renal artery stenosis (ARAS) is a significant cause of end stage renal dysfunction (ESRD) among the elderly. Although early detection of ARAS and induction of adequate treatment could reduce the incidence of ESRD, there have been few reports about parameters predictive of ARAS among Japanese. In this study, we investigated the clinical indicators that predict ARAS among Japanese with risk factors of atherosclerosis (>40 years of age plus hypertension, dyslipidemia or diabetes mellitus). After eliminating the patients who had already been diagnosed with renal artery stenosis, 202 patients were enrolled. The renal arteries of all 202 patients were evaluated by magnetic resonance arteriography (MRA), and the stenoses with >50% reduction in diameter at the ostium of the renal artery were defined as ARAS. MRA detected ARAS in 42 patients (31 hemilateral and 11 bilateral). Between the patients with and without ARAS there was no significant difference in gender distribution, detection of abdominal vascular bruits or smoking habit. The prevalences of diabetic, hypertensive and cerebrovascular comorbidity were also not significantly different. The mean blood pressure, body mass index and total serum cholesterol values were similar between the two groups. However, age, pulse pressure, serum uric acid, serum creatinine, amount of urinary protein, and coronary artery comorbidity were significantly higher, while estimated creatinine clearance was significantly lower in the patients with ARAS than in those without ARAS. A high prevalence of hypertensive retinopathy was also noted among patients with ARAS. Multivariate analysis revealed that older age and renal impairment were independent predictors of ARAS in Japanese patients with atherosclerotic risk factors.
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Safian RD, Textor SC : Renal-artery stenosis. N Engl J Med 2001; 344: 431–442.
Rimmer JM, Gennari FJ : Atherosclerotic renovascular disease and progressive renal failure. Ann Intern Med 1993; 118: 712–719.
Preston RA, Epstein M : Ischemic renal disease: an emerging cause of chronic renal failure and end-stage renal disease. J Hypertens 1997; 15: 1365–1377.
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.
Yang JG, Hu D, Li T, et al: Angiotensin-converting enzyme inhibitor usage in patients with incidental atherosclerotic renal artery stenosis. Hypertens Res 2004; 27: 339–344.
Tan KT, van Beek EJ, Brown PW, van Delden OM, Tijssen J, Ramsay LE : Magnetic resonance angiography for the diagnosis of renal artery stenosis: a meta-analysis. Clin Radiol 2002; 57: 617–624.
Aspelin P, Aubry P, Fransson SG, Strasser R, Willenbrock R, Berg KJ : Nephrotoxic effects in high-risk patients undergoing angiography. N Engl J Med 2003; 348: 491–499.
Zucchelli PC : Hypertension and atherosclerotic renal artery stenosis: diagnostic approach. J Am Soc Nephrol 2002; 13: S184–S186.
Uzu T, Takeji M, Yamada N, et al: Prevalence and outcome of renal artery stenosis in atherosclerotic patients with renal dysfunction. Hypertens Res 2002; 25: 537–542.
Yamashita T, Ito F, Iwakiri N, Mitsuyama H, Fujii S, Kitabatake A : Prevalence and predictors of renal artery stenosis in patients undergoing cardiac catheterization. Hypertens Res 2002; 25: 553–557.
Uzu T, Inoue T, Fujii T, et al: Prevalence and predictors of renal artery stenosis in patients with myocardial infarction. Am J Kidney Dis 1997; 29: 733–738.
Kuroda S, Nishida N, Uzu T, et al: Prevalence of renal artery stenosis in autopsy patients with stroke. Stroke 2000; 31: 61–65.
National Kidney Foundation : K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Am J Kidney Dis 2002; 39 ( Suppl): S76–S110.
Zoccali C, Mallamaci F, Finocchiaro P : Atherosclerotic renal artery stenosis: epidemiology, cardiovascular outcomes, and clinical prediction rules. J Am Soc Nephrol 2002; 13 ( Suppl): S179–S183.
Harding MB, Smith LR, Himmelstein SI, et al: Renal artery stenosis: prevalence and associated risk factors in patients undergoing routine cardiac catheterization. J Am Soc Nephrol 1992; 2: 1608–1616.
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.
Sato A, Saruta T : Aldosterone-induced organ damage: plasma aldosterone level and inappropriate salt status. Hypertens Res 2004; 27: 303–310.
Groholm T, Finckenberg P, Palojoki E, et al: Cardioprotective effects of vasopeptidase inhibition vs. angiotensin type 1-receptor blockade in spontaneously hypertensive rats on a high salt diet. Hypertens Res 2004; 27: 609–618.
Yagi S, Morita T, Katayama S : Combined treatment with an AT1 receptor blocker and angiotensin converting enzyme inhibitor has an additive effect on inhibiting neointima formation via improvement of nitric oxide production and suppression of oxidative stress. Hypertens Res 2004; 27: 129–135.
Blacher J, Staessen JA, Girerd X, et al: Pulse pressure not mean pressure determines cardiovascular risk in older hypertensive patients. Arch Intern Med 2000; 160: 1085–1089.
Inoue T, Matsuoka M, Nagahama K, et al: Cardiovascular risk factors associated with pulse pressure in a screened cohort in Okinawa, Japan. Hypertens Res 2003; 26: 153–158.
Edwards MS, Hansen KJ, Craven TE, et al: Relationships between renovascular disease, blood pressure, and renal function in the elderly: a population-based study. Am J Kidney Dis 2003; 41: 990–996.
Courreges JP, Bacha J, Aboud E, Pradier P : Prevalence of renal artery stenosis in type 2 diabetes. Diabetes Metab 2000; 26: 90–96.
Nunez BD, Frohlich ED, Garavaglia GE, Schmieder RE, Nunez MM : Serum uric acid in renovascular hypertension: reduction following surgical correction. Am J Med Sci 1987; 294: 419–422.
Davis BA, Crook JE, Vestal RE, Oates JA : Prevalence of renovascular hypertension in patients with grade III or IV hypertensive retinopathy. N Engl J Med 1979; 301: 1273–1276.
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Tanemoto, M., Saitoh, H., Satoh, F. et al. Predictors of Undiagnosed Renal Artery Stenosis among Japanese Patients with Risk Factors of Atherosclerosis. Hypertens Res 28, 237–242 (2005). https://doi.org/10.1291/hypres.28.237
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DOI: https://doi.org/10.1291/hypres.28.237
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