Albuminuria predicts renal functional outcome after intervention in atheromatous renovascular disease.
BACKGROUND
Atheromatous renovascular disease is increasingly recognized as a cause of renal failure; however, the benefit of intervention on renal function outcome cannot be clearly anticipated.


OBJECTIVE
To identify reliable predictor(s) of renal functional outcome after revascularization in patients with atheromatous renovascular disease.


METHODS
The effect of percutaneous transluminal renal angioplasty (n = 5) or surgery (n = 18) on glomerular filtration rate ([99mTc]-diethylene triaminopenta-acetic acid clearance) and renal haemodynamics was prospectively assessed in 23 patients with atheromatous renovascular disease (unilateral occlusion in five, unilateral stenosis in four, stenosis of a single kidney in five, unilateral occlusion associated with contralateral stenosis in six, bilateral stenosis in three). Renal function was altered in 18 patients.


RESULTS
At early follow-up study (5 +/- 1 months) after intervention, glomerular filtration rate improved (i.e. increased by more than 15%) in six patients, deteriorated in five and remained unchanged in 12 patients. The change in glomerular filtration rate associated with intervention was inversely correlated with the pre-intervention level of urinary albumin excretion and positively with the change in effective renal plasma flow after intervention. Stepwise regression analysis showed that pre-intervention urinary albumin excretion was the only predictor of the glomerular filtration rate response to intervention. At late follow-up study (32 +/- 6 months, n = 13), glomerular filtration rate was stable compared with early follow-up determination in non-proteinuric patients whereas it had deteriorated further in proteinuric patients.


CONCLUSIONS
In patients with atheromatous renovascular disease, albuminuria may be considered as a marker of pre-existing intra-renal vascular and glomerular damage and a reliable predictor of renal functional outcome after intervention.
Halimi
J M
JM
Department of Medicine, Hôpital Lapeyronie, Montpellier, France.
Ribstein
J
J
Du Cailar
G
G
Ennouchi
J M
JM
Mimran
A
A
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000419:Albuminuria / Q000652:urine*; D017130:Angioplasty; D001161:Arteriosclerosis / Q000628:therapy* / Q000652:urine*; D005260:Female; D005500:Follow-Up Studies; D005544:Forecasting; D005919:Glomerular Filtration Rate; D006439:Hemodynamics; D006801:Humans; D007674:Kidney Diseases / Q000628:therapy* / Q000652:urine*; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D011446:Prospective Studies; D012079:Renal Circulation; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures