title: Detection of occult renovascular disease in unexplained chronic kidney disease.
abstract: Atherosclerotic renal artery stenosis (RAS) is a recognized cause of renal impairment. RAS is often overlooked in unexplained chronic kidney disease (CKD). A retrospective analysis of renal angiograms was performed to determine the prevalence of occult renovascular disease in 64 (M:F, 46:18; ages 21-81 years [median 60 years]) patients with unexplained CKD. Twelve patients had diabetes mellitus (type II: 11) and 43 were smokers. Median serum creatinine was 5.2 mg/dl (range 1.5-10.6 mg/dl). Group A included patients with unexplained CKD and with no risk factors for RAS and Group B had patients with increased risk for RAS. A narrowing of the renal vessel, main artery or branch, by >50% on renal arteriography was used as diagnostic criteria for RAS. 31/64 patients had positive angiographic findings. Thirteen patients had unilateral RAS, 9 had bilateral RAS, 5 had unilateral stenosis with occlusion on the opposite side, 3 had unilateral occlusion and 1 had a solitary kidney with RAS. 19/34 (54%) in Group A and 12/30 (40%) in Group B had a positive renal angiogram. In 10 patients with a rise in serum creatinine on recent introduction of ACE inhibition, 2 had evidence of RAS on renal arteriography. Eleven patients underwent angioplasty and 2 reconstructive surgeries. In 4 patients, blood pressure control improved and anti-hypertensive drug requirements were reduced, whilst renal replacement therapy was postponed in 4, by 2-24 months. In 18 patients, the lesions were not amenable to angioplasty or reconstructive surgery. Four patients did not benefit in any form with intervention. Occult atheromatous renal vascular disease is a common, not readily predictable and potentially correctable etiology of unexplained CKD.
authors.affiliation: Department of Nephrology, St. Bartholomew's Hospital, London, UK. tvachh@lsuhsc.edu
authors.forename: Tushar J
authors.initials: TJ
authors.lastname: Vachharajani
authors.forename: Janet E
authors.initials: JE
authors.lastname: Dacie
authors.forename: Magadi M
authors.initials: MM
authors.lastname: Yaqoob
authors.forename: Anthony E G
authors.initials: AE
authors.lastname: Raine
authors.forename: Laurence R I
authors.initials: LR
authors.lastname: Baker
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015901:Angiography, Digital Subtraction; D017130:Angioplasty; D002908:Chronic Disease; D003404:Creatinine / Q000097:blood; D005260:Female; D006801:Humans; D007674:Kidney Diseases / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D012077:Renal Artery / Q000000981:diagnostic imaging / Q000601:surgery; D012078:Renal Artery Obstruction / Q000097:blood / Q000150:complications* / Q000175:diagnosis* / Q000628:therapy; D012189:Retrospective Studies
chemical_list: D003404:Creatinine