[The changing etiology and therapeutic situation of atherosclerotic renal artery stenosis].
OBJECTIVE
To determine whether the etiology of renal artery stenosis changed. To investigate the clinical characteristics and current therapeutic situation of atherosclerotic renal artery stenosis (ARAS).


METHODS
Retrospective analysis was performed in 144 cases of renal artery stenosis diagnosed by angiography (> or = 50% luminal narrowing) from 1979 to 2003. Eighty-seven of them were diagnosed as ARAS by special characteristics of angiography and clinical features. The clinical data of ARAS was compared with RAS caused by other diseases.


RESULTS
The proportion of ARAS in all RAS was 60.4%. The proportion of ARAS was 28.9% during the period of 1980 to 1990 and 71.7% from the year of 1991 to 2003, respectively. The prevalence of hypertension was 90.8% among ARAS patients. Newly-progressive hypertension was more common among ARAS patients compared with RAS patients with other causes (37.9% vs 21.0%, P = 0.044). Renal dysfunction were more commonly seen among ARAS than non-ARAS patients in those with the same degree of stenosis (11.2% vs 6.9% for stenosis 50%-74%, P = 0.038; 35.8% vs 15.4% for stenosis > or = 75%, P = 0.046). Among ARAS cases, 60.9% were managed with antihypertensive agents only, 18.8% were managed by angioplasty with or without stents. After 1990, the improvement rate of blood pressure rose significantly but not for renal function. The improvement rate of blood pressure by angioplasty was similar with that by medication (84.1% vs 92.6% for stenosis 50%-74%, P = 0.39; 76.6% vs 80.1% for stenosis > or = 75%, P = 0.61). And the improvement or stable rate of renal function was not different (85.4% vs 85.7% for stenosis 50%-74%, P = 0.91; 77.8% vs 76.9% for stenosis > or = 75%, P = 0.83).


CONCLUSIONS
ARAS is the predominant cause of RAS nowadays in stead of Takayasu arteritis. Medication is the mostly used management for ARAS, though more angioplasty with or without stents appear. The effect of medication for ARAS has improved since 1990. Most cases of ARAS could achieve ideal blood pressure control and similar renal function protection with either rational medication or angioplasty.
Wang
Fang
F
Division of Nephrology, First Hospital of Peking University, Beijing 100034, China.
Wang
Mei
M
Liu
Yu-chun
YC
Wang
Hai-yan
HY
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000792:Angiography; D000800:Angioplasty, Balloon; D000959:Antihypertensive Agents / Q000008:administration & dosage; D001161:Arteriosclerosis / Q000150:complications* / Q000628:therapy; D002681:China / Q000453:epidemiology; D005260:Female; D006801:Humans; D006977:Hypertension, Renal / Q000453:epidemiology* / Q000209:etiology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D012078:Renal Artery Obstruction / Q000453:epidemiology* / Q000209:etiology* / Q000628:therapy
D000959:Antihypertensive Agents