Parenchymal consequences of fibromuscular dysplasia renal artery stenosis.
OBJECTIVE
The aim of this study is to assess parenchymal consequences of fibromuscular dysplasia (FMD) renal artery stenosis (RAS) in hypertensive patients by spiral computed tomographic angiography (CTA).


METHODS
Spiral CTA was performed in 20 essential hypertensive (EH) patients (40 EH kidneys and 20 hypertensive patients with unilateral FMD stenosis (20 poststenotic [S] kidneys, 20 opposite [OPP] kidneys). Renal length (RL; in millimeters), mean cortical thickness (MCT; in millimeters), cortical area (CA; in square millimeters), and medullary length (ML; in millimeters) were evaluated.


RESULTS
Blood pressure, creatinine clearance, and long-standing hypertension were similar in both groups of patients. Compared with EH kidneys, S and OPP kidneys showed significant cortical thinning (MCT(EH) = 9.2 +/- 0.8 mm versus MCT(OPP) = 7.8 +/- 1.0 mm versus MCT(S) = 7.3 +/- 1.0 mm; P < 0.0001). RL and ML were reduced only in the S kidney group, with RL(EH) = 103 +/- 11 mm versus RL(OPP) = 105 +/-10 mm versus RL(S) = 96 +/- 11 mm; P = 0.05; and ML(EH) = 84 +/- 11 mm versus ML(OPP) = 89 +/- 9 mm versus ML(S) = 81 +/- 10 mm; P = 0.05, respectively. CA and MCT correlated significantly with creatinine clearance in the entire population (r = 0.43; P = 0.005; r = 0.35; P = 0.02, respectively).


CONCLUSIONS
Unilateral RAS was associated with bilateral cortical thinning in FMD disease. Cortical atrophy appears to be an accurate marker of unilateral RAS. Its use as a potential screening method for RAS should be investigated further.
Mounier-Vehier
Claire
C
Service de Médecine Interne et HTA, Hôpital Cardiologique, CHRU, Lille, France. cmouniervehier@chru-lille.fr
Lions
Christophe
C
Jaboureck
Olivier
O
Devos
Patrick
P
Haulon
Stephan
S
Wibaux
Maud
M
Carré
Alain
A
Beregi
Jean-Paul
JP
D000367:Age Factors; D015901:Angiography, Digital Subtraction / Q000379:methods; D015992:Body Mass Index; D003430:Cross-Sectional Studies; D005260:Female; D005352:Fibromuscular Dysplasia / Q000150:complications*; D006801:Humans; D006978:Hypertension, Renovascular / Q000150:complications; D007672:Kidney Cortex / Q000098:blood supply / Q000473:pathology; D007674:Kidney Diseases / Q000097:blood / Q000209:etiology; D008297:Male; D008875:Middle Aged; D012078:Renal Artery Obstruction / Q000150:complications*; D051437:Renal Insufficiency / Q000097:blood / Q000209:etiology; D012737:Sex Factors; D036542:Tomography, Spiral Computed / Q000379:methods