Proteinuria in atherosclerotic renovascular disease

Abstract

Proteinuria is well described in atherosclerotic renovascular disease (ARVD), but the prevalence is unknown, and the pathogenesis may vary between patients. Substantial proteinuria (> 2 g/day) however, would be regarded by many as atypical of ARVD. We studied 94 patients (52 male) with ARVD, median age 67 years (range 49-87). Digital subtraction angiography was performed on all patients. Protein was assayed in 24-h urine samples and GFR derived using the Cockroft-Gault formula. Forty-nine patients (52%) had proteinuria < 0.5 g/24 h. Proteinuria increased with worsening renal function. Biopsies from seven non-diabetic patients with substantial proteinuria showed: minimal changes (1); glomerular sclerosis with marked ischaemic changes (3); focal glomerulosclerosis (2); and athero-emboli (1). Proteinuria, rather than being indicative of other pathology, is often a marker of severity of parenchymal disorder in atherosclerotic nephropathy, which itself is the major determinant of renal dysfunction in patients with ARVD.

Atherosclerotic ischemic renal disease. Diagnosis and prevalence in an hypertensive and/or uremic elderly population

“…Therefore the exclusion of patients with proteinuria higher than 500 mg/day from further diagnostic procedures for renal artery stenosis, appears to be unjustified [21,22]. More recently the occurrence of marked proteinuria in patients with ischemic nephropathy has been reported [23,24]. Therefore our data support the hypothesis that atherosclerotic renal involvement may be accompanied by pathologic proteinuria.…”

Atherosclerotic renovascular disease in United States patients aged 67 years or older: Risk factors, revascularization, and prognosis

“…However, patient numbers included in each of these trials were small, and none were adequately powered to detect differences in renal function. Other observational studies suggest that up to 75% of atherosclerotic renovascular disease patients fail to derive renal functional benefit from revascularization [22][23][24] and that renal outcomes in atherosclerotic renovascular disease are related more to the severity of proteinuria [25] and renal histopathologic injury [26] than to severity of proximal renal arterial narrowing [27][28][29]. This hypothesis is supported by Doppler ultrasound studies showing that atherosclerotic renovascular disease patients with high renal resistive indices, due to severe intrarenal damage, are unlikely to benefit from revascularization [30].…”

The Effects of Statins on the Progression of Atherosclerotic Renovascular Disease

“…Significant proteinuria has been well described in ARVD patients, and is often a marker of the severity of renal parenchymal damage in ischemic nephropathy [10]. Increases in urinary albumin and protein excretion ratehave been associated with increased cardiovascular and stroke events in patients with non-insulin-dependent diabetes mellitus and non-diabetic subjects [11].…”