Prevalence of angiographic atherosclerotic renal artery disease and its relationship to the anatomical extent of peripheral vascular atherosclerosis.

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Recognition of the possible presence of atherosclerotic renal artery disease (ARAD) is important because of its progressive nature, and because of the potential for precipitating an acute deterioration in renal function by administration of angiotensin-converting enzyme inhibitors. The aim of this study was to identify the prevalence of ARAD in patients undergoing peripheral angiography and its relationship to the extent of their peripheral vascular disease (PVD). The reports of the 218 patients who underwent peripheral angiography to investigate PVD in one centre in a calendar year, and in whom it was possible to image the renal arteries, were analysed retrospectively. The presence of atherosclerotic disease in the renal, aortic, iliac, femoral and distal areas was recorded for each patient. The prevalence of ARAD was 79/218 (36.2%). The greater the number of atherosclerotic areas of the arterial tree, the higher the prevalence of ARAD. Patients with aortic disease and bilateral iliac, femoral and distal vessel disease had the highest incidence of ARAD 19/38 (50%). The incidence of ARAD in those with femoral artery atherosclerosis was significantly higher than in those without femoral artery atherosclerosis (42.1% compared with 9.7%, P=0.001 chi2). There was no significant difference in those groups with or without iliac and distal disease. None of the 11 patients with normal femoral and iliac arteries had ARAD. Renal artery atherosclerosis is a common occurrence in patients with PVD. If extensive PVD is recognized during aortography, a high flush should be considered to examine the renal arteries, if they are not included in the main study.