The profile of cardiac patients with renal artery stenosis

Buller, Christopher E.; Nogareda, Jorge G; Ramanathan, Krishnan; Ricci, Donald R.; Djurdjev, Ognjenka; Tinckam, Kathryn; Penn, I; Fox, Rebecca; Stevens, Lesley A.; Duncan, John A.; Levin, Adeera

doi:10.1016/j.jacc.2003.11.050

Cited by 129 publications

(43 citation statements)

References 23 publications

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“…Additionally, the association between ARAS and CHD suggests that atherosclerosis is a multisystemic disease simultaneously affecting different vascular beds. The hypothesis of a systemic, multiterritory atherosclerotic disease, which would imply a possible association between ARAS and CHD, has also been proposed in other independent studies [2,114,115,116,117,118]. …”

Section: Literature Search Resultsmentioning

confidence: 70%

Atherosclerotic Renal Artery Stenosis: Association with Emerging Vascular Risk Factors

Paraskevas¹,

Hamilton

Cross

et al. 2007

Nephron Clin Pract

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Background: The established risk factors for atherosclerotic renal artery stenosis (ARAS) include hypertension, diabetes mellitus, dyslipidemia, obesity,smoking, old age and family history. In the last few years, several emerging risk factors have been proposed as predictors of ARAS, namely homocysteine, fibrinogen, C-reactive protein, lipoprotein(a) and creatinine. Methods: We searched Pubmed/Medline for studies investigating the prognostic value of each of these emerging risk factors in ARAS. Results: Creatinine and C-reactive protein seem to be the most promising predictors of ARAS, whereas the prognostic value of homocysteine, lipoprotein(a) and fibrinogen is not yet fully determined. Conclusion: The establishment of a definite role for these emerging risk factors could result in earlier recognition and/or better management of ARAS with potential regression/slowing down of progression of stenosis. Modifying these markers may also improve the therapeutic approach of the associated systemic atherosclerosis in these high-risk patients. Future trials should focus on the effect of different classes of drugs (e.g. statins and fibrates) on the levels of the emerging risk factors and the association with ARAS progression.

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Section: Literature Search Resultsmentioning

confidence: 70%

Atherosclerotic Renal Artery Stenosis: Association with Emerging Vascular Risk Factors

Paraskevas¹,

Hamilton

Cross

et al. 2007

Nephron Clin Pract

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“…The literature has extensively reported a high prevalence of unsuspected RAS in patients undergoing coronary angiography: it increased from 7 to 22% in patients with CAD and is much higher in patients with hypertension and an impaired renal function [1,2,3,4,5,6,7] and in patients with established CAD, particularly in those with three-vessel disease. The prevalence of the association of CAD with RAS in patients undergoing coronary angiography having other risk factors ranges from 11 to 18% [8, 9]. …”

Section: Discussionmentioning

confidence: 99%

“…Although the prevalence of renal artery stenosis (RAS) in patients with coronary artery disease (CAD) has been extensively studied [1,2,3,4,5,6,7,8,9,] as well as the predictors of technical success of renal angioplasty and stenting have been well described [10,11,12], the angiographic characteristics of RAS in patients with clinically significant CAD have not been yet fully investigated. We sought to retrospectively evaluate the angiographic characteristics of RAS in patients with CAD.…”

Section: Introductionmentioning

confidence: 99%

Angiographic Characteristics of Renal Arterial Disease over the Spectrum of Coronary Artery Disease

Rigatelli¹,

Roncon²,

Rinuncini³

et al. 2005

Am J Nephrol

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Background/Aim: The angiographic characteristics of renal artery stenoses (RAS) in patients with coronary artery disease (CAD) have not been yet fully investigated. We sought to evaluate the angiographic characteristics of RAS in patients with CAD. Methods: The medical records of consecutive patients who underwentcoronary angiography in a single public institution over a 12-month period were evaluated. The patients who underwent coincident diagnostic renal angiography to evaluate renal vessels on the basis of clinical criteria and who had at least one-vessel CAD were analyzed. Moderate (50–70%) to severe (70–100%) arterial stenoses were noted as significant angiographic findings. The types of stenosis (ostial, true renal, mixed) and presence and location of calcium were recorded. Results: Angiographically significant RAS were reported in 40 (19.5%) of 205 consecutive patients (mean age 67.1 ± 12.8 years, mean serum creatinine concentration 2.1 ± 0.5 mg/dl, mean glomerular filtration rate 52 ± 13 ml/min) for a total of 55 lesions. The RAS severity was moderate in 30.9% (17/55), severe in 69.1% (38/55), ostial in 27.2% (15/55), true renal in 10.9% (6/55), and mixed in 61.8% (34/55) of the patients. The mean lesion length was 16 ± 1.8 mm. Patients with ≧3-vessel CAD had a statistically significantly higher prevalence of mixed calcified RAS (18/24, 75%). Logistic regression analyses revealed ≧3-vessel CAD (odds ratio 9.917, p = 0.002), age >65 years (odds ratio 3.817, p = 0.036), and ≧3 risk factors (odds ratio 2.8, p = 0.048) as independent predictors of RAS. Conclusion: RAS in multivessel CAD patients seems to have a peculiar angiographic pattern, such as a higher prevalence of mixed calcified lesions and poststenotic enlargement, that should be taken in account when dealing with RAS.

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“…The authors developed a scoring system that estimated the pre-angiographic probability of finding lesions of 50% or more with accuracy equal to radionuclide angiography. Buller et al[ 20] describe a patient cohort undergoing cardiac catheterization that was at risk for RAS. Criteria included: uncontrolled hypertension, unexplained impaired kidney dysfunction, (GFR <60 ml/min), flash pulmonary edema, or diffuse atherosclerosis, 28% of the cardiac catheterization population were identified at risk.…”

Section: What Is a Useful Definition Of Ischemic Nephropathy?mentioning

confidence: 99%

Controversies in Renal Artery Stenosis: A Review by the American Society of Nephrology Advisory Group on Hypertension

et al. 2007

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Renovascular hypertension is a recognized secondary potentially curable cause of hypertension since the work of Harry Goldblatt. Operative treatments for renal artery stenosis (RAS) have been offered for decades and percutaneous interventions have been widely available for 20 years. Stenting has largely obviated recurrence and modern techniques have contributed greatly to the safety of the procedure. Nevertheless, controversy abounds and prospective randomized trials have not successfully documented the value of intervention in patients with atherosclerotic RAS. The patient population has also changed remarkably. Whereas earlier patients with RAS were identified on clinical grounds, RAS is now commonly found serendipitously during angiography for other reasons. Whether or not these patients benefit from ‘drive by’ stenting is unknown. The practice may be hazardous and should be critically examined. A dialog and closer cooperation between cardiologists and nephrologists is warranted and organized programs should be formulated to address this problem.

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The profile of cardiac patients with renal artery stenosis

Abstract: In a population at risk of, but not previously suspected of having RAS, severe RAS is associated with simple and readily determined clinical and laboratory patient characteristics. These data facilitate focused application of diagnostic renal angiography.

Cited by 129 publications

References 23 publications

Atherosclerotic Renal Artery Stenosis: Association with Emerging Vascular Risk Factors

Atherosclerotic Renal Artery Stenosis: Association with Emerging Vascular Risk Factors

Angiographic Characteristics of Renal Arterial Disease over the Spectrum of Coronary Artery Disease

Controversies in Renal Artery Stenosis: A Review by the American Society of Nephrology Advisory Group on Hypertension

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