Secondary hypertension: Renovascular hypertension

Abstract

Takayasu’s arteritis is a rare systemic vasculitis mainly affecting the aorta and its major branches. Previous studies have suggested that almost half of the Asian Takayasu’s patients have renal artery involvement. However, due to the rarity of the disease, little is known about renal artery involvement in Chinese Takayasu’s arteritis patients. Here, we retrospectively reviewed and analyzed 411 patients diagnosed with Takayasu’s arteritis in our center to explore the clinical features of renal artery involvement in this group of patients. Of these, 201 patients were diagnosed to have renal artery involvement, with stenosis (78.1%) the most common renal artery pattern. Compared to those without, patients with renal artery involvement were significantly younger at disease onset (23.5 vs 25.6 years) and more frequently had hypertension (74.6% vs 28.1%). Congestive heart failure (22.4% vs 7.6%) and pulmonary hypertension (19.9% vs 9.5%) were both significantly more prevalent among patients with than those without renal artery involvement. The estimated glomerular filtration rate (eGFR) significantly decreased as the severity of renal artery stenosis increased. Age at disease onset older than 24 years (odds ratio 6.06 [95% Confidence Interval 2.76-13.3]), disease duration longer than 19 months (3.35 [1.52-7.4]) and renal artery involvement (8.7 [3.8-20.1]) were independent risk factors for renal dysfunction (eGFR under 90 mL/min/1.73m2) among patients with Takayasu’s arteritis. Thus, patients with renal artery involvement have more severe cardiac and renal dysfunction compared to those without. The eGFR is correlated negatively with the severity of renal artery stenosis.