The natural history of incidental renal artery stenosis in patients with aortoiliac vascular disease.
OBJECTIVE
To examine the association between incidentally discovered renal artery stenosis and deterioration of renal function as determined by the change in serum creatinine concentration over time.


METHODS
We performed a retrospective review of consecutive patients who underwent aortography for aortoiliac vascular disease. Angiograms were reviewed for renal artery stenosis, defined as a narrowing of at least 20% compared with adjacent normal renal artery. For patients with at least 180 days of subsequent follow-up, the change in serum creatinine concentration per year was compared in patients who had or did not have renal artery stenosis.


RESULTS
Of the 201 patients, 96 (48%) had some degree of renal artery stenosis in one or both renal arteries, including 53 (26%) who had at least one stenosis > or= 50% and 40 (20%) who had bilateral stenoses. The only clinical predictor of renal artery stenosis was a history of coronary artery disease (odds ratio = 2.0, 95% confidence interval: 1.2 to 3.8, P = 0.001). Among the 174 patients with > or =180 days of follow-up, there was no statistically significant difference (P = 0.88) in the mean change in serum creatinine concentration per year in the 78 patients with renal artery stenosis (0.06+/-0.33 mg/dL per year) as compared with the 96 patients without renal artery stenosis (0.06+/-0.22 mg/dL per year). Grouping the patients by the maximal percentage of stenosis did not reveal any difference in the mean changes in serum creatinine concentration per year.


CONCLUSIONS
Although renal artery stenosis is a common incidental finding in patients with atherosclerotic vascular disease, it is an uncommon cause of progressive renal disease.
Iglesias
J I
JI
Department of Medicine, Renal Section, Boston University School of Medicine, Boston, Massachusetts, USA.
Hamburger
R J
RJ
Feldman
L
L
Kaufman
J S
JS
D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D000792:Angiography; D001011:Aorta; D001157:Arterial Occlusive Diseases / Q000150:complications*; D003404:Creatinine / Q000097:blood*; D005260:Female; D006801:Humans; D007083:Iliac Artery; D007677:Kidney Function Tests; D008297:Male; D008875:Middle Aged; D012078:Renal Artery Obstruction / Q000097:blood / Q000150:complications* / Q000000981:diagnostic imaging; D012189:Retrospective Studies
D003404:Creatinine