Prevalence and predictors of renal artery stenosis in patients undergoing peripheral and coronary angiography

Shukla, Anand; Madan, Tarun; Jayaram, Ashwal Adamane; Kute, Vivek; Rawal, Jayesh; Manjunath, Anand; Udhreja, Satyam

doi:10.1007/s11255-013-0435-x

Cited by 8 publications

(9 citation statements)

References 17 publications

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“…In addition to hypertension itself [11,12], other traditional cardiovascular risk factors, including aging [12][13][14], diabetes mellitus [11], smoking [12,15], and dyslipidemia [12] have been associated to ARAS, although their role was not confirmed in all studies [16,17]. Moreover, a variety of conditions that are commonly referred as "emergent" risk factors might be associated with ARAS and contribute to its development [18].…”

Section: Introductionmentioning

confidence: 99%

Plasma Lipoprotein(a) Levels and Atherosclerotic Renal Artery Stenosis in Hypertensive Patients

Catena

Colussi

Nait

et al. 2015

Kidney Blood Press Res

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Background/Aims: The contribution of emergent cardiovascular risk factors to atherosclerotic renal artery stenosis (ARAS) is debated. We investigated the relationship of lipoprotein(a) and prothrombotic factors with ARAS in hypertension. Methods: In 50 hypertensive patients with angiographic evidence of ARAS and 58 hypertensive patients who had comparable cardiovascular risk factor burden but no evidence of renovascular disease, we measured renal function, lipoprotein(a), homocysteine, and hemostatic-fibrinolytic markers. Results: Patients with ARAS were more frequently smokers and had longer duration of hypertension, heavier antihypertensive treatment, and worse renal function than controls. Lipoprotein(a) was higher in patients with ARAS than controls, whereas no differences were found in homocysteine and all hemostatic variables. Multivariate analysis showed that lipoprotein(a) was associated with ARAS independent of other confounders including renal function and history of coronary heart, cerebrovascular, and peripheral artery disease. Conclusion: Lipoprotein(a) might contribute to the development of ARAS and detection of elevated levels of this lipoprotein could raise the suspicion of renovascular disease in patients with high blood pressure.

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Section: Introductionmentioning

confidence: 99%

Plasma Lipoprotein(a) Levels and Atherosclerotic Renal Artery Stenosis in Hypertensive Patients

Catena

Colussi

Nait

et al. 2015

Kidney Blood Press Res

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“…The incidence of RAS in the population of patients over 65 years old was reported by Hansen, et al [13] to be near 7% in the general population. However, other studies have shown the prevalence to much higher-as much as 40% in select populations with or at high risk for atherosclerotic disease [1,12,16]. In our population of critically-ill patients, there was a prevalence of nearly 10% among those over 65 and 8% among those with documented cardiovascular or atherosclerotic disease.…”

Section: Discussionmentioning

confidence: 51%

“…Patients with both kidneys, but had a Doppler scan with unilateral diagnostic quality were also excluded. This is because renal artery stenosis occurs unilaterally in most patients [12,13] and these exams were not adequate to define the presence or absence of RAS in the patient based on a unilateral renal scan. From the medical record was recorded the following: sex; age; serum creatinine (mg/dL) and blood urea nitrogen concentrations (mg/dL); number of kidneys; principal diagnosis for admission to ICU; documented history of hypertension, chronic kidney disease, diabetes mellitus, and/or cardiovascular disease; and clinical indications for Doppler screening such as acute kidney injury, hypertensive urgency, flash pulmonary edema, aortic dissection, and sepsis.…”

Section: Methodsmentioning

confidence: 99%

“…In this hilar Doppler study (RHDUS) there is no direct assessment of the renal artery origin or accessory arteries. A 2001 study [12][13][14] looking at using these indirect Doppler parameters as a screening tool for diagnosing RAS found that in a pre-selected group of hypertensive patients, indirect parameters were a useful screening tool. However these indirect parameters have not been studied in the critically-ill population in which they are being employed (Figures 1a and 1b).…”

Section: Introductionmentioning

confidence: 99%

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The value of portable renal hilar Doppler ultrasound screening (RHDUS) for renal artery stenosis in critically-ill patients

Hayes¹,

Amarneh²,

Pollard³

et al. 2017

Vascul Dis Ther

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Purpose: To evaluate the efficacy and utility of portable Renal Hilar Doppler Ultrasound (RHDUS) screening for Renal Artery Stenosis (RAS) in critically-ill patients. Materials and methods:A retrospective study of adult Intensive Care Unit (ICU) patients receiving RHDUS to rule out RAS spanning a time frame of one year. Patients receiving RHDUS were included with the exclusion of patients under 18 years, and exams of poor diagnostic quality. Patients' sex, age, serum creatinine and BUN, risk factors for RAS, and primary and secondary indications for the requested Doppler exam were included. Renal Doppler results and confirmatory studies such as Angiography, MRA, CTA, etc. were included when available.Results: 291 (90%) of 325 Doppler studies were included in the study. Twenty-one of the studies met criteria for possible RAS. Sensitivity and specificity was 80% and 98.5% respectively. A significant association between hypertension-related indications and RAS-positive studies was shown (p=.002). Conclusion:RHDUS is a useful screening test in patients with a high suspicion of RAS. In many ICU patients presenting only with AKI or hemodynamic instability, the use of RHDUS screening for RAS is very low yield and should probably not considered an appropriate test.

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“…Atherosclerotic renal artery stenosis (ARAS), which represents an important proportion of ASCVD cases, is generally recognized to cause renal damage and accounts for 5%-15% of patients who develop end-stage renal disease [15][16][17]. The incidence of symptomless ARAS has been reported to be high in patients undergoing angiography for extrarenal atherosclerotic vascular disease, especially in hypertensive patients [18], reflecting the prevalence of ARAS in systemic atherosclerosis, and that it is commonly overlooked [19][20]. Hypertension can accelerate the progress of ARAS by facilitating lipid deposition, in addition to other traditional CVD risk factors, such as age [21][22], diabetes [23] and smoking [24], which are also related to ARAS.…”

Section: Introductionmentioning

confidence: 99%

Lipoprotein (a) is a residual risk of atherosclerotic renal artery stenosis in hypertensive patients: a hospital-based cross-sectional study

Yang

et al. 2020

Preprint

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Background Low-density lipoprotein cholesterol (LDL-c) has been proven to be a risk factor for atherosclerotic cardiovascular disease (CVD), while lipoprotein (a) (Lp(a)) is a residual risk factor for CVD, even though LDL-c is well controlled by statin use. Importantly, the role of Lp(a) in atherosclerotic renal artery stenosis (ARAS) is still unknown. Methods For this hospital-based cross-sectional study, patients who simultaneously underwent coronary and renal angiography were examined. ARAS was defined as a 50% reduction in the cross-sectional (two-dimensional plane) area of the renal artery. Data were collected and compared between ARAS and non-ARAS groups, including clinical history and metabolite profiles. Univariate analysis, three tertile LDL-c-based stratified analysis, and multivariate-adjusted logistic analysis were conducted, revealing a correlation between Lp(a) and ARAS. Results A total of 170 hypertensive patients were included in this study, 85 with ARAS and 85 with non-RAS. Baseline information indicated comparability between the two groups. In the univariate and multivariate analysis, common risk factors for atherosclerosis were not significantly different. Stratified analysis of LDL-c revealed a significant increase in the incidence of ARAS in patients who had high Lp(a) concentrations at low LDL-c levels (odds ratio (OR): 4.77, 95% confidence interval (CI): 1.04-21.79, P = 0.044). Further logistic analysis with adjusted covariates also confirmed the result, indicating that high Lp(a) levels were independently associated with ARAS (adjusted OR (aOR): 6.14, 95%CI: 1.03-36.47, P = 0.046). This relationship increased with increasing Lp(a) concentration based on a curve fitting graph. These results were not present in the low and intermediate LDL-c-level groups. Conclusion In hypertensive patients who present low LDL-c, high Lp(a) was significantly associated with atherosclerotic renal artery stenosis and thus is a residual risk factor.

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Prevalence and predictors of renal artery stenosis in patients undergoing peripheral and coronary angiography

Cited by 8 publications

References 17 publications

Plasma Lipoprotein(a) Levels and Atherosclerotic Renal Artery Stenosis in Hypertensive Patients

Plasma Lipoprotein(a) Levels and Atherosclerotic Renal Artery Stenosis in Hypertensive Patients

The value of portable renal hilar Doppler ultrasound screening (RHDUS) for renal artery stenosis in critically-ill patients

Lipoprotein (a) is a residual risk of atherosclerotic renal artery stenosis in hypertensive patients: a hospital-based cross-sectional study

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