A prospective study of disease progression in patients with atherosclerotic renal artery stenosis.

Zierler, R. Eugene; Bergelin, Robert O.; Davidson, Robert C.; Cantwell-Gab, Kim; Pollisar, NL; De, Suvranu

doi:10.1016/0895-7061(95)97516-t

Cited by 30 publications

(37 citation statements)

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“…Atherosclerotic renal artery stenosis is a progressive disease: in a prospective study the incidence of progression from less than 60% stenosis to over 60% was 30%, 44%, and 48% at 1, 2, and 3 years respectively 12. With the continued increase in the prescription of angiotensin converting enzyme inhibitors, caution must be exercised to prevent iatrogenic loss of the renal mass.…”

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confidence: 99%

“…With the continued increase in the prescription of angiotensin converting enzyme inhibitors, caution must be exercised to prevent iatrogenic loss of the renal mass. Renal angiography remains the gold standard for diagnosis,13 but renal duplex scanning offers a rapid, non-invasive test for screening for critical renal artery stenosis before starting treatment 12-14. Comparative studies show that duplex ultrasound scanning can reliably predict the presence or absence of significant renal artery stenosis, 12 13 and colour Doppler ultrasonography may be even more sensitive 14…”

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confidence: 99%

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Taking precautions with ACE inhibitors

Kumar

Asim

Davison

1998

BMJ

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confidence: 99%

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confidence: 99%

Taking precautions with ACE inhibitors

Kumar

Asim

Davison

1998

BMJ

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“…Although our study suffers from limitations inherent to retrospective design, there are prospective studies of RVD that utilize renal duplex sonography scan 18-20. Caps et al21 described 170 patients and 295 kidneys with 5-year follow-up.…”

Section: Discussionmentioning

confidence: 99%

Atherosclerotic renovascular disease among hypertensive adults

Davis

Pearce

Craven

et al. 2009

Journal of Vascular Surgery

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Purpose Ths report describes the change in atherosclerotic renovascular disease (AS-RVD) among hypertensive adults referred for renal duplex sonography (RDS) scan. Methods From Oct 1993 through July 2008, 20,994 patients had RDS at our center. A total of 434 hypertensive patients with two or more RDS exams without intervention comprised the study cohort. Patient demographics (blood pressures, medications, serum creatinine levels, and data from RDS) were collected. Analyses of longitudinal changes in Doppler scan parameters, blood pressures, and renal function were performed by fitting linear growth-curve models. After confirming the linearity of change in Doppler scan parameters among patients with variable number of studies, estimates of mean slopes were calculated using maximum likelihood techniques. For changes in renal function, quadratic growth curves were required to describe longitudinal change. Results A total of 434 subjects (212 men [49%] and 222 women [51%]; mean age, 64.6 ± 12.2 years) provided 1351 studies (mean, 3.2 ± 2.4; range, 2 to 18) for 863 kidneys over a mean follow-up of 34.4 ± 25.1 months. At baseline, 20.6% of kidneys demonstrated hemodynamically significant stenosis. On follow-up, 72 kidneys (9.1%) demonstrated anatomic progression of disease. A total of 54 kidneys (6.9%) progressed to significant stenosis and 18 (2.3%) progressed to occlusion. Controlling for progression of disease, baseline renal artery status demonstrated a strong association with baseline kidney length (P = .0006). Significant annualized change in renal length was observed (cm change/year ± standard error of the mean [SEM]: 0.042 ± 0.011; P = .0002) among both kidneys with and without critical disease at baseline, however, decline in length was significantly greater among kidneys exhibiting progression of renovascular disease (−0.152 ± 0.028 cm/year; comparison of slopes between groups P = .0005). In the absence of progression, the presence or absence of critical renal artery stenosis at baseline did not affect the rate of decline in renal length. Fitted models for the natural log transform of serum creatinine demonstrated a significant increase during follow-up (P < .0001). No association was observed between change in serum creatinine and baseline renovascular disease status, or its progression. Conclusion A total of 32% of hypertensive adults referred for RDS demonstrated hemodynamically significant renal artery stenosis. Regardless of the presence or absence of baseline disease, a small percentage of patients demonstrated anatomic progression of AS-RVD. A total of 9.1% demonstrated anatomic progression and 2.3% progressed to occlusion. Although anatomic progression of AS-RVD was associated with an increased rate of decline in renal length, progression did not predict a decline in excretory renal function. Intervention for AS-RVD should be selective and reserved for strict indications.

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“…The risk of progression appears to be determined by the severity of disease at the time of diagnosis. Zierler et al used serial duplex Doppler scans to show that 8% of normal arteries developed a stenosis exceeding 60% at three years whereas 48% of those with a significant but not critical (that is, <60%) stenosis at baseline progressed 14. The reported incidence of complete occlusion ranges from 7% to 16%11 12 14 and this tends to affect kidneys with baseline stenoses exceeding 60% in patients with bilateral disease.…”

Section: Progression Of Arasmentioning

confidence: 99%

Renal failure in atherosclerotic renovascular disease: pathogenesis, diagnosis, and intervention

Woolfson¹

2001

Postgraduate Medical Journal

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A prospective study of disease progression in patients with atherosclerotic renal artery stenosis.

Cited by 30 publications

References 0 publications

Taking precautions with ACE inhibitors

Taking precautions with ACE inhibitors

Atherosclerotic renovascular disease among hypertensive adults

Renal failure in atherosclerotic renovascular disease: pathogenesis, diagnosis, and intervention

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