Cause Of Renal Artery Stenosis Research Articles

Long-term outcomes of percutaneous transluminal renal artery intervention: a retrospective study at a single center

BackgroundThe indications, benefits, and outcomes of percutaneous transluminal renal artery intervention (PTRI) remain controversial. The study purpose was to evaluate the long-term outcomes of PTRI in clinical practice.MethodsA retrospective review of 217 subjects (254 renal arteries; mean age, 59.8 years) who underwent PTRI based on medical database.ResultsThe most common cause of renal artery stenosis was atherosclerosis in 217 (85.4%), followed by Takayasu arteritis (TA) in 23 (9.1%), fibromuscular dysplasia in five (2.0%) and others in nine (3.5%). Mean follow-up duration was 5.7 ± 3.7 years. The first restenosis rate was 7.5% (n = 19; highest in TA: n = 9, 47.4%) and second restenosis occurred in six arteries (five TAs, one fibromuscular dysplasia). Follow-up blood pressure improved from 142.0/83.5 to 122.8/73.5 mmHg (P < 0.001). There was no change within 5 years’ follow-up in estimated glomerular filtration rate (P = 0.44), whereas TA changed from 69.8 ± 20.5 to 84.2 ± 17.9 mL/min/1.73 m² (P = 0.008). Progressive renal dysfunction was related to diabetes mellitus, chronic kidney disease, and peripheral artery obstructive disease on multivariate analysis with hazard ratios (95% confidence intervals) of 2.24 (1.21–4.17), 2.54 (1.33–4.84), and 3.93 (1.97–7.82), respectively.ConclusionsPTRI was associated with a blood pressure reduction. Despite a higher rate of restenosis, patients with TA showed significant improvement in estimated glomerular filtration rate. Diabetes mellitus, chronic kidney disease, and peripheral artery obstructive disease were related with progressive renal dysfunction after PTRI.

Emerging approaches in secondary hypertension due to renal artery stenosis: evaluation and treatment - systematic review

Hypertension, a global health concern, affects a staggering 1.28 billion people worldwide, as stated by the World Health Organization (WHO) however renal artery stenosis (RAS), a common cause of secondary hypertension, is characterized by the narrowing of renal arteries, leading to physiological changes such as arterial stiffening and elevated blood pressure. The major causes of RAS include atherosclerosis and fibromuscular dysplasia. Diagnosis involves clinical suspicion and imaging studies such as Doppler ultrasonography and angiography. Treatment strategies encompass lifestyle modifications, pharmacotherapy, interventional procedures like angioplasty with stenting, and emerging options such as renal denervation and gene therapy. Our aim is to provide a comprehensive examination of the pathophysiology, prevalence, risk factors, causes, diagnosis, and treatment modalities through a systematic search gathering qualitative and quantitative data. We address the challenges in diagnosis and treatment, emphasizing the need for tailored approaches considering patient-specific factors. We will review emerging approaches in evaluating and treating secondary hypertension due to RAS.

#6682 RENAL ARTERY STENOSIS: A SINGLE CENTRE STUDY

Abstract Background and Aims Renal artery stenosis (RAS) is present from 1% to 5% in people affected by arterial hypertension and it is often associated with peripheral artery disease and coronary artery disease; as the matter of fact, it is commonly found in people undergoing cardiac catheterization (18-20%) or angiography for aorto-iliac and lower extremities diseases. The major cause of renal artery stenosis is an atherosclerotic lesion localized in the proximal segment or to the ostium. Clinical presentations are renovascular hypertension and ischemic nephropathy. The aim of the study is to define either endovascular treatment gives a significant benefit on renal function and blood pressure control, when associated to medical therapy. Method This is a retrospective study focused on patients who underwent renal artery angioplasty and stenting in the last ten years, from November 2011 to April 2021 in the Nephrology Department, at Sant'Andrea Hospital, La Spezia (Italy). The primary outcome was kidney function, while secondary outcomes were blood pressure and the number of antihypertensive drugs one year after the revascularization. Patients included in the study had uncontrolled and refractory arterial hypertension (PA ≥140/90 mmHg) and/or progressive worsening of renal function, secondary to bilateral or unilateral stenosis in one functional kidney, that was identified at the color-doppler ultrasound examination by a peak systolic velocity (PSV) &amp;gt;200 ml/min and an aortic-renal ratio &amp;gt;3,5. We found 36 patients who had these characteristics. They were all affected by chronic kidney disease (CKD) (mean±SD eGFR 25,3±15,3 ml/min/1,73 m2) equally divided into stage 3 (33%, eGFR 30-60 ml/min/1,73 m2), stage IV (31% eGFR 15-29 ml/min/1,73 m2) and stage V (36%, eGFR &amp;lt;15 ml/min/1,73 m2). Results Kidney function, measured as serum creatinine (SCr) (mg/dl), improved immediately after the revascularization (mean ± SD SCr after vs before 2,52 ± 1,61 vs 3,31 ± 2,47 mg/dl p&amp;lt;0.05), after 30 days (mean ± SD SCr after vs before creat. 2,36 ± 1,53 vs 3,19 ± 2,39 mg/dl p&amp;lt;0.05) and after one year (mean ± SD SCr after vs before creat. 2,04 ± 1,16 vs 2,99 ± 2,40 mg/dl p&amp;lt;0.05) (Fig. 1). Regarding arterial hypertension, a significant reduction of both systolic (SBP) and diastolic (DBP) blood pressure was detected in the subgroup of people under 75 years old (mean ± SD SBP after vs before, 144,62 ± 12,55 vs 168,18 ± 36,40 mmHg, p&amp;lt; 0,01; after one year vs before, 143,95 ± 21,10 vs 167,83 ± 38,16 mmHg, p&amp;lt;0.05) (mean ± SD DBP after vs before, 73,62 ± 9,62 vs 83,07 ± 21,75 mmHg, p&amp;lt; 0,05; after one year vs before 75,20 ± 9,02 vs 83,33 ± 23,10 mmHg, p = 0.07) (Fig. 2). The number of antihypertensive drugs dropped immediately after the angioplasty (mean ± SD tablets after vs before 2,28 ± 1,11 vs 3,21 ± 1,43, p&amp;lt;0.01), while after one year there was not a significant increase of therapy (mean ± SD tablets after one year vs before, 3,00 ± 1,41 vs 3,23 ± 1,42, p = 0,47), even if blood pressure was better controlled than before the procedure with the same amount of tablets (Fig. 3). Conclusion Although our population was quite small, we demonstrated the advantages of renal artery revascularization in atherosclerotic renovascular disease, as demonstrated by kidney function and blood pressure control. Our results contrast the larger studies considered, that found no relevant clinical benefit on renal function and incidence of major adverse cardiovascular and renal events by comparing patients treated with medical therapy alone or with medical therapy plus angioplasty. The different conclusions are probably due to our strict adhesion to the endovascular treatment indications, which consider the revascularization as the optimal strategy for a well-defined population.

TRANSLUMINAL ANGIOPLASTY OF THE RENAL ARTERIES IN PATIENTS WITH FIBROMUSCULAR DYSPLASIA

Objective: FMD is the second most frequent cause of renal artery stenosis (RAS) after atherosclerosis and can lead to hypertension. To cure or improve this renovascular hypertension, patient with fibromuscular dysplasia and renal artery stenosis undergo renal artery revascularization by percutaneous renal transluminal angioplasty (PTRA). Although this method has been performed for many years, there have been only few small size trials published. This retrospective single center study aimed to evaluate the rate of cured hypertension after PTRA. Design and method: We included all adult patients diagnosed with FMD who were seen in our referral center for hypertension management (Hôpital Européen Georges Pompidou, Paris) from January 2010 to March 2020. Blood pressure response was assessed at 3 month and one year. Primary outcome was one year cured hypertension rate in ambulatory measurement, secondary outcomes were improvement and complication rate. Results: Overall, 76 adult patients (87% female, mean age at enrollment 35.5 years) were included. FDM was multifocal in 74% and unisite in 68% of patients. AT baseline, mean day ambulatory blood pressure (dABP) was 141 ± 17/89 ± 14 mmHg under a mean of 2.3 ± 1.37 antihypertensive treatments. All patient underwent PTRA. Stent were inserted in 8 patients (10.5%) with residual stenosis after PTRA and in 8 patients (10.5%) with renal artery dissection, total complication rate was 18.4%. At one-year follow-up, mean dABP was 128 ± 12/78 ± 9 mmHg (p &lt; 0.0001) with 1.1 ± 1.3 treatments (p &lt; 0.0001). In total, 75% beneficiated from renal angioplasty: 31% were cured and 44% were improved. Cured hypertension was associated with low body mass index (BMI) (p = 0.017) and unisite FDM (p = 0.017) on a multivariable analysis. Conclusions: In patients with FMD, PTRA is associated with cured hypertension 31% of patients with renal artery FMD undergoing PRTA. Hypertension is more likely to be cured in patient with low BMI and multisite FMD. These results are to be put in perspective with a complication rate of 18.4%.

Cardiovascular Disease Prevention in Patients With Atherosclerotic Renovascular Disease-Induced Resistant Hypertension: Further Considerations for 24-Hour BloodPressure Profiles.

Cardiovascular Disease Prevention in Patients With Atherosclerotic Renovascular Disease-Induced Resistant Hypertension: Further Considerations for 24-Hour BloodPressure Profiles.

Reversible hypertension and infective arteritis

Background: Idiopathic vasculitides or arteritis have very few or none treatment options. Identification of infective arteritis based on high clinical suspicion opens a window for treatment of such cases . Although these are occasional clinical scenario. Aims and Objectives: To identify the treatable cause of arteritis and starting initial treatment based on clinical suspicion. Material and Methods: Based on high clinical suspicion we aim to identify chronic infective cause of arteritis among patients of SS Hospital from 2019 to 2020 coming in EOPD. Results and Discussion: Three cases of reversible hypertension from different clinical setup relating to a common infective etiology, i.e., tuberculosis identified during the said duration, all cases presented with constitutional symptoms for 2–6 months with headache, loss of appetite, fever, and malaise. The first case presented as acute abdomen in EOPD having mesenteric ischemia and hypertension. The second case presented in antenatal care OPD with hypertension which was nonrelated to pregnancy. The third case presented in medicine OPD as a case of young hypertensive without mood changes. Partial renal artery stenosis relating to infective arteritis was a common finding in all cases. All cases responded well with the firstline antitubercular medication and became normotensive (without medication) in the follow up. Conclusion: The cause of renal artery stenosis appeared to be related to tubercular arteritis of vessel with either a past history of pulmonary TB or TB contact. Renovascular tubercular arteritis has been defined in only a few literatures and only handful of cases being reported making worth presentation.

Beyond Atherosclerosis and Fibromuscular Dysplasia: Rare Causes of Renovascular Hypertension.

Renovascular hypertension is one of the most common forms of secondary hypertension. Over 95% of cases of renovascular hypertension are due either to atherosclerosis of the main renal artery trunks or to fibromuscular dysplasia. These two causes of renal artery stenosis have been extensively discussed in recent reviews and consensus. The aim of the current article is to provide comprehensive and up-to-date information on the remaining causes. While these causes are rare or extremely rare, etiologic and differential diagnosis matters both for prognosis and management. Therefore, the clinician cannot ignore them. For didactic reasons, we have grouped these different entities into stenotic lesions (neurofibromatosis type 1 and other rare syndromes, dissection, arteritis, and segmental arterial mediolysis) often associated with aortic coarctation and other arterial abnormalities, and nonstenotic lesions, where hypertension is secondary to compression of adjacent arteries and changes in arterial pulsatility (aneurysm) or to the formation of a shunt, leading to kidney ischemia (arteriovenous fistula). Finally, thrombotic disorders of the renal artery may also be responsible for renovascular hypertension. Although thrombotic/embolic lesions do not represent primary vessel wall disease, they are characterized by frequent macrovascular involvement. In this review, we illustrate the most characteristic aspects of these different entities responsible for renovascular hypertension and discuss their prevalence, pathophysiology, clinical presentation, management, and prognosis.

Atherosclerotic renal artery stenosis: epidemiology, etiology, diagnostics and treatment

Paulius Burkauskas1, Karolina Baltrušaitytė1, Ernestas Margelis2 1Lithuanian University of Health Sciences, Academy of Medicine, Faculty of Medicine, Kaunas, Lithuania 2Hospital of Lithuanian University of Health Sciences, Kaunas Clinics, Department of Surgery, Kaunas, Lithuania Abstract Renal artery stenosis is a form of peripheral artery disease that occurs in 1-5% patients with arterial hypertension. Arterial atherosclerosis, which also occurs in other blood vessels, has the greatest impact on the development of the renal artery stenosis. Narrowing of the renal artery activates the renin-angiotensin-aldosterone system, which can cause patients to have high blood pressure that is difficult to correct with multiple medications. As the disease progresses, concentric hypertrophy of the left ventricle develops and, if decompensated, episodes of flash pulmonary edema may occur. Thus, renal artery stenosis affects not only the kidneys but also the entire cardiovascular system. Aim: to select and analyze expert presented causes, diagnostics and recommendations for the treatment of atherosclerotic renal artery stenosis. Methods: the review of literature was conducted using the medical database, selecting publications investigating the burden of atherosclerotic renal artery stenosis. Conclusions: the most common cause of renal artery stenosis is atherosclerosis. The gold standard for the diagnosis of renal artery stenosis is direct renal artery angiography. The main method of treatment for atherosclerotic renal artery stenosis is medication. Keywords: peripheral arterial disease, hypertension, flash pulmonary edema, renal artery stenosis. https://doi.org/10.53453/ms.2021.06.3

Etiology spectrum and clinical characteristics of renal artery stenosis in a Chinese cohort.

OBJECTIVETo analyze the causes of renal artery stenosis (RAS) and compare the clinical characteristics in accordance with the primary disease among patients aged from 30 to 50.METHODSPatients were grouped by etiologies of RAS. Groups were retrospectively examined and compared regarding demographic data, clinical manifestations, laboratory findings, and imaging findings.RESULTSA total of 152 patients (74 females, 78 males; mean age: 40.70 ± 6.01 years) were enrolled, including 84 patients (55.3%) with atherosclerosis (AS), 46 patients (30.3%) with Takayasu arteritis (TA), 18 patients (11.8%) with fibromuscular dysplasia (FMD), and four patients (2.6%) with other etiologies. Patients in AS group had greater body mass index, higher prevalence of comorbidities and higher rate of smoking and drinking history. TA patients showed more constitutional symptoms and vascular findings, and higher erythrocyte sedimentation rate. RAS in both AS group and TA group mainly located on ostia and proximal segments, but RAS in FMD group mainly involved middle to distal segment of renal artery. The AS group had significantly lesser stenosis than the other groups. Although renal function evaluated by the estimated glomerular filtration rate did not significantly differ among the groups, the incidence of kidney shrinkage was significantly higher in the TA and FMD groups (39.1% and 50%, respectively) than in the AS group (8.3%). The FMD group had milder cardiac damage than other groups.CONCLUSIONSAS was the most common cause of RAS in patients aged from 30 to 50, followed by TA and FMD. The etiology of RAS should be carefully distinguished based on clinical manifestations, laboratory findings, and imaging to ensure that proper treatment is provided.

Case report: secondary hypertension in a 6-year old child with bilateral renal artery stenosis

Background. Renovascular hypertension (RVH) is an elevated blood pressure caused by partial or complete occlusion of one or both renal arteries or their branches. According to different studies, renal artery stenosis accounts for 5–10% of all cases of hypertension in children. The most common causes of renal artery stenosis are deemed to be atherosclerosis and fibromuscular dysplasia.Case description. The article describes clinical case of a newly diagnosed renovascular hypertension amid background of fibromuscular dysplasia of renal arteries in a 6-year old child, particulars of the clinical course, laboratory and instrumental methods of investigation and treatment including aortography and balloon angioplasty of renal arteries.Conclusion. This case report illustrates that in the absence of complaints and pronounced clinical symptoms the diagnosis of renovascular hypertension in a 6-year old child could not be established for a long time. Timely detection of elevated BP in children, including the young ones, not only during visiting specialist physicians but also during prophylactic examination by pediatrician, is required for early diagnosis of the disease and development of the examination and treatment strategy.

Case report: secondary hypertension in a 6-year old child with bilateral renal artery stenosis

Background. Renovascular hypertension (RVH) is an elevated blood pressure caused by partial or complete occlusion of one or both renal arteries or their branches. According to different studies, renal artery stenosis accounts for 5–10% of all cases of hypertension in children. The most common causes of renal artery stenosis are deemed to be atherosclerosis and fibromuscular dysplasia.Case description. The article describes clinical case of a newly diagnosed renovascular hypertension amid background of fibromuscular dysplasia of renal arteries in a 6-year old child, particulars of the clinical course, laboratory and instrumental methods of investigation and treatment including aortography and balloon angioplasty of renal arteries.Conclusion. This case report illustrates that in the absence of complaints and pronounced clinical symptoms the diagnosis of renovascular hypertension in a 6-year old child could not be established for a long time. Timely detection of elevated BP in children, including the young ones, not only during visiting specialist physicians but also during prophylactic examination by pediatrician, is required for early diagnosis of the disease and development of the examination and treatment strategy.

Case report: secondary hypertension in a 6-year old child with bilateral renal artery stenosis

Background. Renovascular hypertension (RVH) is an elevated blood pressure caused by partial or complete occlusion of one or both renal arteries or their branches. According to different studies, renal artery stenosis accounts for 5–10% of all cases of hypertension in children. The most common causes of renal artery stenosis are deemed to be atherosclerosis and fibromuscular dysplasia.Case description. The article describes clinical case of a newly diagnosed renovascular hypertension amid background of fibromuscular dysplasia of renal arteries in a 6-year old child, particulars of the clinical course, laboratory and instrumental methods of investigation and treatment including aortography and balloon angioplasty of renal arteries.Conclusion. This case report illustrates that in the absence of complaints and pronounced clinical symptoms the diagnosis of renovascular hypertension in a 6-year old child could not be established for a long time. Timely detection of elevated BP in children, including the young ones, not only during visiting specialist physicians but also during prophylactic examination by pediatrician, is required for early diagnosis of the disease and development of the examination and treatment strategy.

Renal Artery Stenosis in the Patient with Hypertension: Prevalence, Impact and Management.

Atherosclerosis is the primary cause of renal artery stenosis. Atherosclerotic renal artery stenosis (ARAS) is associated with three clinical problems: renovascular hypertension, ischemic nephropathy and cardiac destabilization syndrome which pose huge healthcare implications. There is a significant rate of natural disease progression with worsening severity of renal artery stenosis when renal revascularization is not pursued in a timely manner. Selective sub-groups of individuals with ARAS have had good outcomes after percutaneous renal artery stenting (PTRAS). For example, individuals that underwent PTRAS and had improved renal function were reported to have a 45% survival advantage compared to those without improvement in their renal function. Advances in the imaging tools have allowed for better anatomic and physiologic measurements of ARAS. Measuring translesional hemodynamic gradients has allowed for accurate assessment of ARAS severity. Renal revascularization with PTRAS provides a survival advantage in individuals with significant hemodynamic renal artery stenosis lesions. It is important that we screen, diagnosis, intervene with invasive and medical treatments appropriately in these high-risk patients.

Renal Artery Stenosis As Etiology of Recurrent Flash Pulmonary Edema and Role of Imaging in Timely Diagnosis and Management.

Renal hypoperfusion from renal artery stenosis (RAS) activates the renin-angiotensin system, which in turn causes volume overload and hypertension. Atherosclerosis and fibromuscular dysplasia are the most common causes of renal artery stenosis. Recurrent flash pulmonary edema, also known as Pickering syndrome, is commonly associated with bilateral renal artery stenosis. There should be a high index of clinical suspicion for renal artery stenosis in the setting of recurrent flash pulmonary edema and severe hypertension in patients with atherosclerotic disease. Duplex ultrasonography is commonly recommended as the best initial test for the detection of renal artery stenosis. Computed tomography (CT) angiography (CTA) or magnetic resonance (MR) angiography (MRA) are useful diagnostic imaging studies for the detection of renal artery stenosis in patients where duplex ultrasonography is difficult. If duplex ultrasound, CTA, and MRA are indeterminate or pose a risk of significant renal impairment, renal angiography is useful for a definitive diagnosis of RAS. The focus of medical management for RAS relies on controlling renovascular hypertension and aggressive lifestyle modification with control of atherosclerotic disease risk factors. The restoration of renal artery patency by revascularization in the setting of RAS due to atherosclerosis may help in the management of hypertension and minimize renal dysfunction.

Renal artery stenosis: the challenging in diagnosis and therapy

Hypertension is still the most prevalent non-communicable diseases in Indonesia. Renovascular hypertension is one type of secondary hypertension. It is commonly caused by the presence of renal artery stenosis (RAS). Whereas, atherosclerosis (ARAS) and fibromuscular disease (FMD) are the most common causes of RAS. Early diagnosis is necessary because it has the potential to be cured by eliminating stenosis of the renal artery. However, the signs and symptoms of renovascular hypertension are not specific. The supporting examination to diagnose RAS is also expensive. So, screening in the population at risk is needed. The examinations to prove the presence of RAS are arteriography, captopril renogram, renal ultrasonography, renal Doppler ultrasonography, magnetic resonance angiography (MRA), and computed angiographic tomography (CTA).&#x0D; Until now, three therapeutic modalities can be selected in the management of renovascular hypertension; pharmacological therapy, surgical intervention, percutaneous intervention angioplasty with and without stenting. This narrative review summarizes the literature focused on the diagnosis and therapy of RAS.

Renovascular Hypertension: Novel Insights.

Renovascular hypertension (RVH) remains among the most prevalent and important, but also potentially reversible, causes of secondary hypertension. The predominant causes of renal artery stenosis (RAS) are atherosclerotic renovascular arterial stenosis (ARAS) and renal fibromuscular dysplasia. This condition can lead to progressive renal injury, cardiovascular complications and 'flash pulmonary edema'. Duplex Doppler ultrasonography, computed tomographic angiography and magnetic resonance angiography are the most commonly used diagnostic methods. There are three therapeutic options available: medical therapy including renin-angiotensin-aldosterone system antagonists, lipid-lowering agents, and antiplatelet therapy, percutaneous angioplasty with or without stent placement and surgical revascularization. Three large trials failed to demonstrate the superiority of renal artery revascularization over pharmaceutical therapy in controlling blood pressure and preserving renal function. For this reason, today revascularization is only recommended for patients with progressive worsening of renal function, recurrent 'flash pulmonary edema' and rapid increase in antihypertensive requirement in patients with previously well-controlled hypertension. However, more properly designed trials are needed in order to identify which patient populations would probably benefit from renal revascularization.

Renal Artery Stenosis: The Challenging in Diagnosis and Therapy

Hypertension is still the most prevalent of non-communicable diseases in Indonesia. Renovascular hypertension is one type of secondary hypertension. It is commonly caused by the presence of renal artery stenosis (RAS). Whereas, atherosclerosis (ARAS) and fibromuscular disease (FMD) are the most common causes of RAS. Early diagnosis is necessary because it has the potential to be cured by eliminating stenosis of the renal artery. However, the signs and symptoms of renovascular hypertension are not specific. The supporting examination to diagnose RAS is also expensive. So, screening in the population at risk is needed. The examinations to prove the presence of RAS are arteriography, captopril renogram, renal ultrasonography, renal Doppler ultrasonography, magnetic resonance angiography (MRA), and computed angiographic tomography (CTA). Until now, three therapeutic modalities can be selected in the management of renovascular hypertension; pharmacological therapy, surgical intervention, percutaneous intervention angioplasty with and without stenting. This narrative review summarizes the literature focused on the diagnosis and therapy of RAS.

A case of refractory hypertension in young age

Renal artery stenosis (RAS) is most common cause of secondary hypertension and accounts for approximately 1–3% of all causes of hypertension. Fibromuscular dysplasia (FMD) is important cause of RAS in young patients. Various therapeutic options are currently available for patients with renovascular hypertension: medical antihypertensive therapy, surgical revascularisation and transluminal angioplasty including stent implantation. We present in this report a female patient with left renal artery &amp; left renal atrophy and segmental marked stenosis of supra renal aorta who presented with hypertensive encephalopathy &amp; viral meningitis. Patient was successfully treated with antiviral agent.Bangladesh Crit Care J September 2018; 6(2): 102-104

Time trends regarding the etiology of renal artery stenosis: 18years' experience from the China Center for Cardiovascular Disease.

The time trends regarding the etiology of renal artery stenosis (RAS) are changing, but few investigations have focused on these issues. This study aimed to analyze the time trends regarding the etiology of RAS in a large patient sample from the China Center for Cardiovascular Disease. Consecutive inpatients with RAS from January 1999 to December 2016 were enrolled in this study. The etiologic diagnosis of RAS was based on established criteria. We retrospectively analyzed the time trends regarding the etiology of RAS during an 18-year period. A total of 2905 patients with RAS were enrolled. There were 2393 (82.4%) patients with atherosclerosis (AS), 345 (11.9%) with Takayasu arteritis (TA), 126 (4.3%) with fibromuscular dysplasia (FMD), and 41 (1.4%) with other causes. Among all patients (n=2905), patients aged ≤40years (n=450), patients aged >40years (n=2455), female patients (n=1097), male patients (n=1808), female patients aged >40years (n=808), and male patients aged >40years (n=1647), there were a gradual increase in the proportion of atherosclerotic RAS (P<0.05), a gradual decrease in the proportion of RAS caused by TA (P<0.05), and almost no change in the proportion of RAS caused by FMD during the 18-year period (P>0.05). The data show that the primary causes of RAS are AS, TA, and FMD. The proportion of RAS caused by AS and TA gradually increased and decreased, respectively, over time, and the proportion of RAS caused by FMD showed no significant change.

ESH-ENDORSED EUROPEAN/INTERNATIONAL FIBROMUSCULAR DYSPLASIA REGISTRY

Objective: The pioneering works of French and United States research teams have changed our conception of Fibromuscular Dysplasia (FMD) from a rare cause of renal artery stenosis in young women to a more frequent, often systemic vascular disease, which can be diagnosed at all ages, both in men and women. We report here the main characteristics of the first 609 patients enrolled in the European/International FMD registry endorsed by the ESH. Design and method: The current analysis was performed in 609 patients enrolled from November 2015 to January 2018 in 30 centres from 17 countries also including 3 extra-European countries (Argentina, Japan and Tunisia). Results: Enrolled patients were predominantly women (83%) and Caucasians (88%). Age at diagnosis was 45.8 ± 15.8 years, 74% of patients were hypertensive, 72% had a multifocal FMD and 31% multivessel FMD. Family history of FMD was reported in 2.7% of cases. Compared to patients with multifocal FMD, patients with focal FMD were younger (39.2 ± 15.9 vs. 48.4 ± 14.9 years, p = 0.003), more often male (26% vs. 13%, p = 0.0002), had less often multivessel FMD (12% vs. 39%, p = 0.0001) and more frequent revascularization interventions (70% vs. 50%, p = 0.01). Compared to patients with single-vessel FMD, patients with multivessel FMD were older (49.5 ± 14.2 vs. 44.1 ± 16.1 years, p = 0.03), had lower eGFR (84.2 ± 28.1 vs. 94.4 ± 40.6 mL/min, p = 0.0005) and were more frequently of the multifocal subtype (89% vs. 64%, p = 0.00001). Notably, the proportion of arterial dissections was higher in men than in women (12% vs. 2%, p = 0.01). Conclusions: The main findings of the European/International FMD registry are in line with those of the French-Belgian ARCADIA study and the United States registry, with the exception of a lower proportion of multivessel FMD, which probably reflects a lack of systematic vascular exploration in some centres. In the near future, the European/International FMD registry will make possible further comparisons between old and young, incident and prevalent patients, and/or patients from different ethnicities or regions of the world. Accumulation of follow-up data may also provide insights on predictive factors of progression/complication.