title: Atherosclerotic ischemic renal disease. Diagnosis and prevalence in an hypertensive and/or uremic elderly population.
abstract: BACKGROUND
  Atherosclerotic ischemic renal disease is a frequent cause of end-stage renal failure leading to dialysis among the elderly; Its prevalence is inferred from autopsy or retrospective arteriographic studies. This study has been conducted on 269 subjects over 50 with hypertension and/or CRF, unrelated to other known causes of renal disease.
  
  
  METHODS
  All 269 patients were studied either by color-flow duplex sonography (n = 238) or by renal scintigraphy (n = 224), and 199 of the 269 patients were evaluated using both of these techniques. 40 patients, found to have renal artery stenosis (RAS), were subjected to 3D-contrast enhancement Magnetic Resonance Angiography (MRA) and/or Selective Angiography (SA). An additional 23 cases, negative both to scintigraphy and to ultrasound study, underwent renal angiography (MRA and/or SA).
  
  
  RESULTS
  Color-duplex sonography, carried out in 238 patients, revealed 49 cases of RAS. MR or SA was carried out in 35 of these 49 patients, and confirmed the diagnosis in 33. Color-duplex sonography showed a PPV value of 94.3% and NPV of 87.0% while renal scintigraphy, carried out in 224 patients, had a PPV of 72.2% and a NPV of 29.4%. Patients with RAS showed a higher degree of renal insufficiency compared to non stenotic patients while there were no differences in proteinuria. RAS, based on color-duplex sonography studies, was present in 11% of patients in the age group 50-59, 18% in the 60-69 and 23% at age 70 and above.
  
  
  CONCLUSIONS
  A relatively large percentage of the elderly population with renal insufficiency and/or hypertension is affected by RAS and is at risk of developing end-stage renal failure. Color-duplex ultrasonography is a valid routine method of investigation of population at risk for renal artery stenosis.
authors.affiliation: Renal Pathophysiology and Hypertension Unit, Second Medical Faculty, La Sapienza University, Rome, Italy. coen.gf@flashnet.it
authors.forename: Giorgio
authors.initials: G
authors.lastname: Coen
authors.forename: Santo
authors.initials: S
authors.lastname: Calabria
authors.forename: Silvia
authors.initials: S
authors.lastname: Lai
authors.forename: Eleonora
authors.initials: E
authors.lastname: Moscaritolo
authors.forename: Italo
authors.initials: I
authors.lastname: Nofroni
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Ronga
authors.forename: Michele
authors.initials: M
authors.lastname: Rossi
authors.forename: Guido
authors.initials: G
authors.lastname: Ventroni
authors.forename: Daniela
authors.initials: D
authors.lastname: Sardella
authors.forename: Michele
authors.initials: M
authors.lastname: Ferrannini
authors.forename: Alvaro
authors.initials: A
authors.lastname: Zaccaria
authors.forename: Rosario
authors.initials: R
authors.lastname: Cianci
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications; D007676:Kidney Failure, Chronic / Q000209:etiology; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012078:Renal Artery Obstruction / Q000175:diagnosis / Q000453:epidemiology*; D012307:Risk Factors; D014511:Uremia / Q000150:complications