Renal artery stenosis by three-dimensional magnetic resonance angiography in type 2 diabetics with uncontrolled hypertension and chronic renal insufficiency: prevalence and effect on renal function.
BACKGROUND
The variable course of renal disease in type 2 diabetes mellitus in part may reflect associated atherosclerotic nephropathy.


METHODS
To determine the influence of subcritical (<65%) renal artery stenosis (RAS) on the progression of chronic kidney disease, 45 patients with type 2 diabetes with uncontrolled hypertension and serum creatinine levels of 1.8 mg/dL or greater (>/=159.1 micromol/L) were screened by three-dimensional magnetic resonance angiography (MRA). Mean monthly decrease in reciprocal serum creatinine x 100 and time to initiation of dialysis therapy, adjusting for baseline serum creatinine level, were compared in those with and without RAS. Follow-up was censored at the time of death or angioplasty.


RESULTS
At baseline, RAS-negative (RAS(-); n = 27) and RAS-positive (RAS(+); n = 18) groups were similar in duration of diabetes and hypertension, hyperlipidemia, blood pressure, diabetic management, and renal function. RAS(+) subjects were older (P = 0.04) and more likely to have claudication (P = 0.006), smoke (P = 0.02), and have heart disease (P = 0.06). During a median follow-up of 9.4 months, 3 patients underwent stent placement, 2 patients died, and 12 patients progressed to dialysis therapy. The RAS(+) group had a more rapid monthly decline in reciprocal serum creatinine x 100 (mean, 1.63 +/- 0.9 versus 0.69 +/- 1.0 [SD]; P = 0.04). The relative risk for progression to end-stage renal disease was 2.4 in the RAS(+) versus RAS(-) group. Multivariate analysis showed that this effect was not independent of several established atherosclerotic risk factors.


CONCLUSIONS
MRA-detected RAS is common (40%) in patients with type 2 diabetes with uncontrolled hypertension and renal insufficiency. Subcritical (<65%) RAS is a significant risk factor for progressive renal failure.
Myers
Donna I
DI
Johns Hopkins University School of Medicine, Baltimore, MD, USA. dimyers@welch.jhu.edu
Poole
Lynn J
LJ
Imam
Khursheed
K
Scheel
Paul J
PJ
Eustace
Joseph A
JA
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015142:Baltimore / Q000453:epidemiology; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000503:physiopathology*; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000453:epidemiology* / Q000209:etiology* / Q000503:physiopathology; D021621:Imaging, Three-Dimensional / Q000379:methods; D007676:Kidney Failure, Chronic / Q000453:epidemiology* / Q000209:etiology / Q000628:therapy; D018810:Magnetic Resonance Angiography / Q000379:methods; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D015995:Prevalence; D012078:Renal Artery Obstruction / Q000175:diagnosis* / Q000453:epidemiology* / Q000473:pathology / Q000628:therapy; D006435:Renal Dialysis / Q000379:methods / Q000706:statistics & numerical data; D012307:Risk Factors; D015607:Stents