Background: Atherosclerotic renal artery stenosis (ARAS) is an important cause of renal disease in the elderly, and these patients have a high morbidity and mortality. There are no data on their blood lipid profiles. Methods: The lipoprotein profiles were examined in patients with proven ARAS and compared with patients matched for age, gender, renal function and presence of diabetes. Results: The profiles did not show any significant difference for apolipoprotein B (control 1.31 ± 0.39 vs. ARAS 1.24 ± 0.28; mean ± SD), cholesterol (control 5.65 ± 1.28 vs. ARAS 6.12 ± 1.29), LDL cholesterol (control 3.72 ± 1.03 vs. ARAS 4.06 ± 1.18), fibrinogen (control 2.48 ± 1.39 vs. ARAS 3.29 ± 1.49), HDL cholesterol (control 1.16 ± 0.38 vs. ARAS 1.00 ± 0.26) and triglyceride (control 1.68 ± 0.80 vs. ARAS 2.32 ± 1.73) levels between the groups. Surprisingly lipoprotein(a) levels were higher in the control group (0.58 ± 0.45) vs. ARAS (0.31 ± 0.21). The most striking abnormality was the markedly lower apolipoprotein A1 levels in the ARAS group (control 2.09 ± 0.55 vs. ARAS 0.95 ± 0.30) and apolipoprotein A1/B ratio (control 1.74 ± 0.71 vs. ARAS 0.78 ± 0.24). Conclusion: The lipoprotein abnormality in ARAS mirrors that in other severe vascular diseases. Potential therapeutic interventions in patients with ARAS should consider treatments to modify the apolipoprotein A1 concentration rather than cholesterol alone.

Pregnancy has not hitherto been known to influence the course of Churg-Strauss syndrome. We describe a case where relapse occurred in four successive pregnancies. The disease proved fatal in the last pregnancy when aggressive treatment failed to reverse fulminant cardiac disease.

SummaryThe proportion of patients with vasculitis and rapidly progressive nephritis aged 70 years or over has risen from about 10% in the 1980s to over 30% in series reported in the 1990s. This study was undertaken to examine the presentation and outcome of such older patients. Seventeen of 56 patients (30%) who presented at two renal units were aged 70 years or over. Mean creatinine level at presentation was 530 ytmol/l, and five patients received dialysis at presentation. Outcome was dependent on three factors, namely comorbid pathology, response to immunosuppressive therapy, and the occurrence in three cases of temporary spontaneous partial remission. Overall patient survival at one and two years was 62.5% and 50%, respectively, and 90% and 100% of surviving patients were independent of dialysis at one and two years, respectively. Response to chemotherapy was excellent, with full rehabilitation in many cases and no deaths directly attributable to adverse effects of immunosuppressive therapy. We conclude that diagnosis ofvasculitis and rapidly progressive glomerulonephritis by renal biopsy and the subsequent administration of chemotherapy (including cyclophosphamide in many cases) resulted in a worthwhile benefit in these elderly patients.

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