Incidental atherosclerotic renal artery stenosis in patients undergoing elective coronary angiography: are these lesions significant?
BACKGROUND
Cardiologists often identify atherosclerotic renal artery stenosis (ARAS) during cardiac angiography. The importance of such 'incidental' ARAS (iARAS) is not known. The present study sought to describe renal perfusion using non-captopril (baseline) nuclear renograms in patients with iARAS, and to determine characteristics associated with a positive captopril renogram.


METHODS
Patients presenting for non-emergent coronary angiography between June 2001 and February 2006 were angiographically screened for iARAS. Those with >50% stenosis of one or both renal arteries were referred to nephrology and underwent nuclear renography.


RESULTS
131 patients had renograms. The mean age was 73.2 +/-8.1 and median eGFR was 51.2 (40.0, 66.6) ml/min/1.73 m(2). 51% had evidence of reduced perfusion to one kidney, of which 13% were discordant with the angiographic lesion. 9% had positive captopril renograms. Captopril renogram positivity was associated with severe unilateral stenosis (p = 0.02).


CONCLUSIONS
In cardiac patients diagnosed with iARAS, the presence of known anatomic lesions did not correlate with captopril renogram positivity. Uncertainty remains as to whether nuclear renography is a poor functional test in this population, or the lesions are not functionally significant. These results lead us to question both the significance of such lesions, and the utility of conducting renograms in this population.
Schachter
M E
ME
Division of Nephrology, University of British Columbia, St. Paul's Hospital, 1081 Burrard Street, Vancouver, B.C., Canada. mschac1@hotmail.com
Zalunardo
N
N
Rose
C
C
Taylor
P
P
Buller
C
C
Kiaii
M
M
Duncan
J
J
Levin
A
A
D000368:Aged; D000369:Aged, 80 and over; D000959:Antihypertensive Agents; D050197:Atherosclerosis / Q000175:diagnosis*; D002216:Captopril; D015331:Cohort Studies; D017023:Coronary Angiography; D005260:Female; D006801:Humans; D033162:Incidental Findings; D008297:Male; D008403:Mass Screening; D012078:Renal Artery Obstruction / Q000175:diagnosis*; D012189:Retrospective Studies
D000959:Antihypertensive Agents; D002216:Captopril