The profile of cardiac patients with renal artery stenosis.
OBJECTIVE
We examined the prevalence and severity of renal artery stenosis (RAS) in patients undergoing cardiac catheterization who were deemed at risk for RAS based on clinical or laboratory criteria for study entry, but who had not previously been suspected of having RAS.


BACKGROUND
The diagnosis of atherosclerotic RAS remains problematic because its clinical manifestations are nonspecific.


METHODS
Consecutive patients undergoing non-emergent cardiac catheterization at a single institution during a 12-month period were evaluated using standardized clinical, laboratory, and angiographic criteria. Patients exhibiting at least one of four predefined selection criteria (severe hypertension, unexplained renal dysfunction, acute pulmonary edema with hypertension, or severe atherosclerosis) were prospectively registered and underwent coincident diagnostic renal angiography.


RESULTS
Renal angiography was performed in 851 patients and was diagnostic in 837. Angiographically evident renal atherosclerosis was present in 39% of the population, with RAS > or =50% in 120 (14.3%) and severe stenosis (> or =70%) in 61 (7.3%). Severe stenosis was present in 48 (7%) patients with severe atherosclerosis, 38 (16%) with renal dysfunction, 25 (9%) with hypertension, and 2 (22%) with acute pulmonary edema with hypertension. The prevalence was higher in those exhibiting multiple selection criteria. In a multivariate model, severe RAS was associated with age, female gender, reduced creatinine clearance, increased systolic blood pressure, and peripheral or carotid artery disease.


CONCLUSIONS
In a population at risk of, but not previously suspected of having RAS, severe RAS is associated with simple and readily determined clinical and laboratory patient characteristics. These data facilitate focused application of diagnostic renal angiography.
Buller
Christopher E
CE
Department of Medicine, Division of Cardiology, University of British Columbia, Vancouver, Canada. cbuller@providencehealth.bc.ca
Nogareda
Jorge G
JG
Ramanathan
Krishnan
K
Ricci
Donald R
DR
Djurdjev
Ognjenka
O
Tinckam
Kathryn J
KJ
Penn
Ian M
IM
Fox
Rebecca S
RS
Stevens
Lesley A
LA
Duncan
John A
JA
Levin
Adeera
A
D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002170:Canada / Q000453:epidemiology; D006328:Cardiac Catheterization; D017023:Coronary Angiography; D003327:Coronary Disease / Q000175:diagnosis* / Q000453:epidemiology; D005260:Female; D006801:Humans; D006978:Hypertension, Renovascular / Q000175:diagnosis / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D017060:Patient Satisfaction; D015995:Prevalence; D011446:Prospective Studies; D012372:ROC Curve; D012078:Renal Artery Obstruction / Q000175:diagnosis* / Q000453:epidemiology; D051437:Renal Insufficiency / Q000175:diagnosis / Q000453:epidemiology; D012720:Severity of Illness Index; D012737:Sex Factors