Natural history of atherosclerotic renal artery stenosis associated with aortic disease

Abstract

The natural history of atherosclerotic renal artery stenosis has not been well defined, particularly when discovered in conjunction with aortic disease requiring correction. To better define the natural history of such lesions, 194 sequential aortograms in 48 patients were studied to define predictive criteria for stenoses at risk for progression. Sixty-six unsuspected atherosclerotic renal arterial stenoses were identified on the initial aortograms. Disease progressed in 42 arteries (53%), 14 bilateral and 28 unilateral. Seven arteries developed occlusion. All had stenoses averaging 80% (range 61% to 94%) noted on the most recent aortogram preceding occlusion. Risk factors including smoking, diabetes mellitus, elevated serum lipids, coronary artery disease, peripheral arterial disease, or change in blood pressure or creatinine, did not correlate with degree or rate of progression of the renal artery stenosis. A difference in kidney size, although varying inversely with degree of stenosis, was not a statistically significant marker of disease progression. This analysis suggests that identification of renal arterial stenoses that will progress is best determined by sequential aortography. Highly stenotic vessels are more prone to occlude than those less stenotic. Consequently, individuals with preocclusive lesions should benefit from prophylactic renal revascularization during aortic reconstruction.

Incidental Renal Artery Stenosis Is an Independent Predictor of Mortality in Patients with Peripheral Vascular Disease

“…Studies on its natural history (6,15,29,30) reported that progression to end-stage renal failure is rare (6,7). From the perspective of preservation of renal function, therefore, revascularization is not recommended for patients with incidentally discovered RAS (6,7).…”

Determinants of renal function in patients with renal artery stenosis

“…Over 1-4 years atherosclerotic stenoses may progress anatomically; however, progression to occlusion is infrequent. [2][3][4][5] In some patients, RAS is associated with loss of renal size, a crude measure of renal function. 5 In the setting of a significant RAS (60-99%), up to a quarter of kidneys demonstrate atrophy of > 1 cm in length, 6,7 whereas loss of renal size is uncommon without RAS.…”

Índice de resistividade renal como preditor da revascularização renal para hipertensão renovascular

“…Duplex ultrasound has been used to evaluate the results and followup of surgical as well as endovascular interventions 5,15,16 . Few studies investigated whether a high level of resistance to flow in segmental renal arteries measured by duplex US could be used to select appropriate patients for treatment [17][18][19] .…”

“…Reports on the natural history of renal artery stenosis have shown progression of renal artery stenosis in 30% to 53% of patients monitored for up to 10 years 4,5 . Loss of renal mass is also an important consequence of high-grade Patient's clinical features and ultrasound findings were compared in two groups of patients: with resistance index smaller than 80 and with resistance index greater or equal to 80.…”