Etiology of renal artery stenosis in 2047 patients: a single-center retrospective analysis during a 15-year period in China

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Abstract

Systematic investigation with large sample size of the distribution of etiologies of renal artery stenosis (RAS) is scant in both Western countries and China. We retrospectively analyzed the etiology of RAS in 2047 consecutive inpatients diagnosed with RAS for hypertension at Fuwai Hospital between 1999 and 2014. The number of patients with atherosclerosis was 1668 (81.5%), 259 (12.7%) with Takayasu’s arteritis (TA), 86 (4.2%) with fibromuscular dysplasia (FMD), 34 (1.6%) with other causes. There was an obvious increase with age in the proportion of atherosclerotic RAS (P<0.001). In patients aged 40 years (n=319) the predominant etiology of RAS was TA (60.5%), followed by FMD (24.8%). In patients aged >40 years (n=1728) the major cause of RAS was atherosclerosis (94.7%), followed by TA (3.8%).The proportion of TA and FMD in female patients was significantly higher than that in male patients (P<0.001). In female patients aged 40 years (n=215), the top three etiologies of RAS were TA (68.4%), FMD (27.9%) and atherosclerosis (1.4%). The present analysis showed that atherosclerosis, TA and FMD were sequentially the top three causes of RAS in the National Center of China. Age and gender had a significant effect on the distribution of etiologies of RAS.

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References

  1. 1

    Simon N, Franklin SS, Bleifer KH, Maxwell MH . Clinical characteristics of renovascular hypertension. JAMA 1972; 220: 1209–1218.

  2. 2

    Anderson GH Jr, Blakeman N, Streeten DH . The effect of age on prevalence of secondary forms of hypertension in 4429 consecutively referred patients. J Hypertens 1994; 12: 609–615.

  3. 3

    de Mast Q, Beutler JJ . The prevalence of atherosclerotic renal artery stenosis in risk groups: a systematic literature review. J Hypertens 2009; 27: 1333–1340.

  4. 4

    Safian RD, Textor SC . Renal-artery stenosis. N Engl J Med 2001; 344: 431–442.

  5. 5

    Bobrie G . Obstructive lesions of the renal arteries: etiology and prevalence. Rev Prat 1996; 46: 1070–1075.

  6. 6

    Albers FJ . Clinical characteristics of atherosclerotic renovascular disease. Am J Kidney Dis 1994; 24: 636–641.

  7. 7

    Textor SC . Ischemic nephropathy: where are we now? J Am Soc Nephrol 2004; 15: 1974–1982.

  8. 8

    Prisant LM, Szerlip HM, Mulloy LL . Fibromuscular dysplasia: an uncommon cause of secondary hypertension. J Clin Hypertens (Greenwich) 2006; 8: 894–898.

  9. 9

    European Society of Hypertension-European Society of Cardiology Guidelines Committee. 2003 European Society of Hypertension-European Society of Cardiology guidelines for the management of arterial hypertension. J Hypertens 2003; 21: 1011–1053.

  10. 10

    Levey AS, Bosch JP, Lewis JB, Greene T, Rogers N, Roth D . A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Modification of Diet in Renal Disease Study Group. Ann Intern Med 1999; 130: 461–470.

  11. 11

    Cooper WA, O'Brien SM, Thourani VH, Guyton RA, Bridges CR, Szczech LA et al. Impact of renal dysfunction on outcomes of coronary artery bypass surgery: results from the Society of Thoracic Surgeons National Adult Cardiac Database. Circulation 2006; 113: 1063–1070.

  12. 12

    Suzuki H, Nakamoto H, Nemoto H, Sugahara S, Okada H . Control of blood pressure and prevention of end-organ damage in patients with accelerated hypertension by combination with arotinolol and extended release nifedipine. Hypertens Res 2000; 23: 159–166.

  13. 13

    Hirsch AT, Haskal ZJ, Hertzer NR, Bakal CW, Creager MA, Halperin JL et al. ACC/AHA 2005 Practice Guidelines for the management of patients with peripheral arterial disease (lower extremity, renal, mesenteric, and abdominal aortic): a collaborative report from the American Association for Vascular Surgery/Society for Vascular Surgery, Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, Society of Interventional Radiology, and the ACC/AHA Task Force on Practice Guidelines (Writing Committee to Develop Guidelines for the Management of Patients With Peripheral Arterial Disease): endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation; National Heart, Lung, and Blood Institute; Society for Vascular Nursing; TransAtlantic Inter-Society Consensus; and Vascular Disease Foundation. Circulation 2006; 113: e463–e654.

  14. 14

    Chrysochou C, Kalra PA . Epidemiology and natural history of atherosclerotic renovascular disease. Prog Cardiovasc Dis 2009; 52: 184–195.

  15. 15

    Tanemoto M, Saitoh H, Satoh F, Satoh H, Abe T, Ito S . Predictors of undiagnosed renal artery stenosis among Japanese patients with risk factors of atherosclerosis. Hypertens Res 2005; 28: 237–242.

  16. 16

    Bookstein JJ, Abrams HL, Buenger RE, Lecky J, Franklin SS, Reiss MD et al. Radiologic aspects of renovascular hypertension. 1. Aims and methods of the radiology study group. JAMA 1972; 220: 1218–1224.

  17. 17

    Sharma BK, Siveski-Iliskovic N, Singal PK . Takayasu arteritis may be underdiagnosed in North America. Can J Cardiol 1995; 11: 311–316.

  18. 18

    Persu A, Touze E, Mousseaux E, Barral X, Joffre F, Plouin PF . Diagnosis and management of fibromuscular dysplasia: an expert consensus. Eur J Clin Invest 2012; 42: 338–347.

  19. 19

    International Study Group for Behcet's Disease. Criteria for diagnosis of Behcet's disease. Lancet 1990; 335: 1078–1080.

  20. 20

    Lightfoot RW Jr, Michel BA, Bloch DA, Hunder GG, Zvaifler NJ, McShane DJ et al. The American College of Rheumatology 1990 criteria for the classification of polyarteritis nodosa. Arthritis Rheum 1990; 33: 1088–1093.

  21. 21

    Chaillou P, Moussu P, Noel SF, Sagan C, Pistorius MA, Langlard JM et al. Spontaneous dissection of the celiac artery. Ann Vasc Surg 1997; 11: 413–415.

  22. 22

    Maxwell MH, Bleifer KH, Franklin SS, Varady PD . Cooperative study of renovascular hypertension. Demographic analysis of the study. JAMA 1972; 220: 1195–1204.

  23. 23

    Chaudhry MA, Latif F . Takayasu's arteritis and its role in causing renal artery stenosis. Am J Med Sci 2013; 346: 314–318.

  24. 24

    Bicakcigil M, Aksu K, Kamali S, Ozbalkan Z, Ates A, Karadag O et al. Takayasu’s arteritis in Turkey – clinical and angiographic features of 248 patients. Clin Exp Rheumatol 2009; 27: S59–S64.

  25. 25

    Kendrick J, Chonchol M . Renal artery stenosis and chronic ischemic nephropathy: epidemiology and diagnosis. Adv Chronic Kidney Dis 2008; 15: 355–362.

  26. 26

    Koide K . Takayasu arteritis in Japan. Heart Vessels 1992; 7: 48–54.

  27. 27

    Yang L, Zhang H, Jiang X, Zou Y, Qin F, Song L et al. Clinical manifestations and longterm outcome for patients with Takayasu Arteritis in China. J Rheumatol 2014; 41: 2439–2446.

  28. 28

    Kincaid OW, Davis GD, Hallermann FJ, Hunt JC . Fibromuscular dysplasia of the renal arteries. Arteriographic features, classification, and observations on natural history of the disease. Am J Roentgenol Radium Ther Nucl Med 1968; 104: 271–282.

  29. 29

    Trinquart L, Mounier-Vehier C, Sapoval M, Gagnon N, Plouin PF . Efficacy of revascularization for renal artery stenosis caused by fibromuscular dysplasia: a systematic review and meta-analysis. Hypertension 2010; 56: 525–532.

  30. 30

    Cooper CJ, Murphy TP, Cutlip DE, Jamerson K, Henrich W, Reid DM et al. Stenting and medical therapy for atherosclerotic renal-artery stenosis. N Engl J Med 2014; 370: 13–22.

  31. 31

    Hirsch AT, Haskal ZJ, Hertzer NR, Bakal CW, Creager MA, Halperin JL et al. ACC/AHA Guidelines for the Management of Patients with Peripheral Arterial Disease (lower extremity, renal, mesenteric, and abdominal aortic): a collaborative report from the American Associations for Vascular Surgery/Society for Vascular Surgery, Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, Society of Interventional Radiology, and the ACC/AHA Task Force on Practice Guidelines (writing committee to develop guidelines for the management of patients with peripheral arterial disease)—summary of recommendations. JVIR 2006; 17: 1383–1397.

  32. 32

    Bax L, Woittiez AJ, Kouwenberg HJ, Mali WP, Buskens E, Beek FJ et al. Stent placement in patients with atherosclerotic renal artery stenosis and impaired renal function: a randomized trial. Ann Intern Med 2009; 150: 840–848.

  33. 33

    Wheatley K, Ives N, Gray R, Kalra PA, Moss JG, Baigent C et al. Revascularization versus medical therapy for renal-artery stenosis. N Engl J Med 2009; 361: 1953–1962.

  34. 34

    Sharma S, Thatai D, Saxena A, Kothari SS, Guleria S, Rajani M . Renovascular hypertension resulting from nonspecific aortoarteritis in children: midterm results of percutaneous transluminal renal angioplasty and predictors of restenosis. AJR Am J Roentgenol 1996; 166: 157–162.

  35. 35

    Tyagi S, Singh B, Kaul UA, Sethi KK, Arora R, Khalilullah M . Balloon angioplasty for renovascular hypertension in Takayasu's arteritis. Am Heart J 1993; 125: 1386–1393.

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Correspondence to X-j Jiang.

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