Nephrotic-range proteinuria in patients with renovascular disease.
OBJECTIVE
Proteinuria is usually considered a manifestation of glomerular disease. We sought to describe the characteristics of patients with nephrotic-range proteinuria resulting from renovascular disease and to compare them with those of patients who had glomerulonephritis.


METHODS
We identified 14 patients with nephrotic-range proteinuria and renovascular disease and compared them with 14 patients who had nephrotic-range proteinuria and biopsy-proven glomerulonephritis, matched for sex, age, and glomerular filtration rate.


RESULTS
Patients with renovascular disease were more likely to have known atherosclerotic vascular disease [13 of 14 (93%) vs 3 of 14 (21%), P < 0.0001) and were usually smokers [12 of 14 (85%) vs 3 of 14 (21%), P < 0.0001]. They also had a greater mean (+/- SD) difference between the lengths of their kidneys (29 +/- 10 vs 5 +/- 5 mm, P < 0.001); greater systolic blood pressure (203 +/- 22 vs 174 +/- 25 mm Hg, P < 0.005), plasma renin activity (17 +/- 19 vs 2 +/- 2 ng/mL/h, P = 0.005), and plasma aldosterone concentration (40 +/- 23 vs 11 +/- 10 ng/dL, P = 0.0001); and lower serum potassium levels (3.3 +/- 0.5 vs 3.8 +/- 0.5, P <0.05). Effective renal plasma flow was lower (139 +/- 68 vs 307 +/- 185 mL/min/1.73 m3) and filtration fraction was markedly greater (0.28 +/- 0.04 vs 0.15 +/- 0.07, P = 0.0001) in the patients with renovascular disease. After the oral administration of captopril, blood pressure, effective renal plasma flow, and glomerular filtration rate decreased only among patients with renovascular disease. Of the 14 patients with renovascular disease, 13 had evidence of renal artery thrombosis seen at angiography; 2 patients required dialysis, and 3 others died during follow-up.


CONCLUSIONS
Our findings suggest that the patients with nephrotic-range proteinuria resulting from renovascular disease have distinct characteristics and a poor prognosis.
Halimi
J M
JM
Department of Medicine and Hypertension, H pital Lapeyronie, Centre Hospitalier Universitaire, Montpellier, France.
Ribstein
J
J
Du Cailar
G
G
Mimran
A
A
D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use; D002216:Captopril / Q000627:therapeutic use; D016022:Case-Control Studies; D003937:Diagnosis, Differential; D005260:Female; D005500:Follow-Up Studies; D005921:Glomerulonephritis / Q000097:blood / Q000150:complications* / Q000175:diagnosis* / Q000503:physiopathology / Q000652:urine; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D006978:Hypertension, Renovascular / Q000097:blood / Q000150:complications* / Q000175:diagnosis* / Q000188:drug therapy / Q000503:physiopathology / Q000652:urine; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009401:Nephrosis / Q000652:urine*; D011507:Proteinuria / Q000097:blood / Q000209:etiology* / Q000503:physiopathology / Q000652:urine; D012307:Risk Factors; D013997:Time Factors
D000959:Antihypertensive Agents; D002216:Captopril