Predictors Of Renal Artery Stenosis Research Articles

The Incidence and Predictors of Renal artery Stenosis in Patients Referred for Coronary Angiography

Background: Renal artery stenosis (RAS) and coronary artery disease (CAD) are two manifestations of a same pathogenesis which is atherosclerosis.. RAS is a leading factor of secondary hypertension, ischemic nephropathy and end stage renal disease (ESRD). Aim of work: This study was aimed to detect the incidence and predictors of renal artery stenosis in patients referred for elective coronary angiography. Patients and Methods: In this study we included 100 patients who underwent coronary and renal angiography.The mean age was 56.6 + 7.9 years, 60 males (60%), 40 females (40%), 60 diabetic (60%), 58 hypertensive (58%), 41 smokers (41%), 62 dyslipidemic (62%), 27 patients with family history of ischemic heart disease (27%), and patient with normal coronaries 12 (12 %). Our study consisted of 2 groups; 87 (87%) patients with normal renal arteries (group 1) and 13 (13%) patients with renal artery stenosis (group 2). Results: The incidence of RAS was 13% and the incidence of significant RAS (>50% stenosis) was 7%. The significant difference between the two groups was in the terms of hypertension (p-value 0.014), female gender (p-value 0.021), multivessel (> 2 vessels) coronary artery disease (p-value 0.046), normal coronaries had a significant negative association with RAS (p-value 0.027) and there was a significant relationship between atherosclerotic involvement of Left anterior descending artery (LAD), Diagonal, and right coronary artery (RCA) with RAS (p-value 0.037, 0.041 and 0.042). Conclusion: It could be concluded that predictors of RAS were hypertension, multivessel coronary artery disease (> 2 vessels) and female gender.

The Incidence and Predictors of Renal artery Stenosis in Patients Referred for Coronary Angiography

The Incidence and Predictors of Renal artery Stenosis in Patients Referred for Coronary Angiography

Predictors of renal artery stenosis in patients undergoing cardiac catheterization for suspected coronary artery disease

AimThis study determined the prevalence of Renal Artery Stenosis (RAS) and established its predictors in patients undergoing cardiac catheterization for suspected Coronary Artery Disease (CAD). Methods1266 patients underwent coronary angiogram for suspected CAD. Following coronary angiogram, bilateral selective renal angiogram was performed. Study population was split into cohorts with and without RAS. A binary logistic regression model was used to identify univariate predictors of RAS. Significant univariate predictors were used to build a multivariate logistic regression model. Comparative accuracy of various models in predicting RAS was estimated by computing areas under the Receiver Operating Characteristic (ROC) curve. ResultsPrevalence of significant RAS in study population was 6.0%. In univariate analysis, mean age (p = 0.002), diabetes mellitus (p = 0.009), hypertension of more than five years duration (p = 0.034), serum creatinine concentration of >1 mg per 100 ml (p = 0.009), peripheral arterial disease (p = 0.019), and significant CAD (p = 0.037) were predictors of RAS. In the multivariate analysis, serum creatinine concentration (p = 0.002), peripheral arterial disease (p = 0.017), Two-vessel CAD (p = 0.043), and Three-vessel CAD (p = 0.007) were independent predictors of RAS. Areas under the non-crossing ROC curves revealed that a simple model incorporating two-vessel CAD and three-vessel CAD had an acceptable accuracy in predicting RAS. ConclusionIt may not be appropriate to extrapolate the findings of research conducted in other demographic settings to Indian patients. “Drive by” renal angiogram in Indian settings may be done only in patients with multi-vessel CAD presenting with indisputable clinical indications. However, in the long run, we should be open to new research.

Renal Artery Stenosis and Acute Pulmonary Edema-A Possible Correlation beyond Pickering Syndrome

Objectives: The association of renal artery stenosis (RAS) with acute pulmonary edema (APE) is considered specific for bilateral or solitary functioning kidney (SFK) RAS. We aimed to check if APE is also associated with unilateral RAS when both kidneys are functional. Method: A series of 189 patients with uncontrolled hypertension were investigated for RAS suspicion by duplex ultrasonography. Clinical criteria considered in current guidelines as predictors of RAS were recorded and analysed. Results: Potentially hemodynamically significant RAS (≥ 50%) was identified in 29% of cases (55/189): unilateral in 35 cases (group A), bilateral or on SFK in 20 cases (group B). The remaining 134 were designated controls (group C). Age, blood pressure and gender did not differ between groups. The presence of acute pulmonary edema was higher in both groups of patients with RAS (23%-group A (p<0.01) and 20%-group B vs 8% in control group). The prevalence of azotemia and of azotemia under angiotensin converting enzyme inhibitors or angiotensin II receptor blockers were significantly higher in group B (p<0.01 vs. group A, p<0.00001 vs. control). Linear discriminant analysis based on: age, gender, abdominal bruit, vascular disease, renal dysfunction and azotemia under angiotensin converting inhibitors or angiotensin II receptor blockers, had an accuracy of 0.70 for unilateral RAS, 0.85 for bilateral/SFK RAS, and 0.77 for both. This accuracy was not improved when adding APE as a predictive variable. Conclusions: In a series of hypertensive patients evaluated for renovascular disease the prevalence of APE is higher in patients with RAS. We have found a significant association of RAS with APE for unilateral RAS. This association, little emphasized until present, might contribute to the clarification of the flash pulmonary edema mechanisms beyond those related to bilateral/SFK RAS.

Prevalence and predictors of renal artery stenosis in patients undergoing peripheral and coronary angiography

Renal artery stenosis is a potential cause of secondary hypertension, ischemic nephropathy and end-stage renal disease. Atherosclerosis is by far the most common etiology of renal artery stenosis in elderly. We investigated whether the presence of significant atherosclerotic renal artery stenosis (ARAS) with luminal diameter narrowing ≥50 % could be predicted in patients undergoing peripheral and coronary angiography. The records of 3,500 consecutive patients undergoing simultaneous renal angiography along with peripheral and coronary angiography were reviewed. The patients with known renal artery disease were excluded. Prevalence of ARAS was 5.7 %. Significant ARAS (luminal diameter narrowing ≥50 %) was present in 139 patients (3.9 %). Hypertension with altered serum creatinine and triple-vessel CAD were associated with significant renal artery stenosis in multivariate analysis. No significant relationship between the involved coronary arteries like left anterior descending, left circumflex, right coronary artery and ARAS was found. Only hypertension and altered serum creatinine were associated with bilateral ARAS. Extent of CAD or risk factors like diabetes, hyperlipidemia or smoking did not predict the unilateral or bilateral ARAS. Prevalence of ARAS among the patients in routine cardiac catheterization was 5.7 %. Hypertension is closely associated with significant ARAS. Significant CAD in the form of triple-vessel disease and altered renal function tests are closely associated with ARAS. They predict the presence of significant renal artery stenosis in patients undergoing routine peripheral and coronary angiography. Moreover, hypertension and altered renal functions predict bilateral ARAS.

Frequency and Predictors of Renal Artery Stenosis in Hypertensive Patients Undergoing Coronary Angiography

Renal artery stenosis (RAS) and coronary artery disease share common risk factors. We investigated the frequency and predictors of RAS among hypertensive patients who underwent elective coronary angiography. A total of 832 hypertensive patients underwent coronary and renal angiography at the same session. Renal artery stenosis was classified as mild, moderate, or severe. The study population consisted of 4 groups; 71.1% with normal renal arteries, 12.5% with mild, 8.9% with moderate, and 7.5% with severe RAS. The prevalence of significant (≥50%) RAS was 16.3%. The Gensini score showed a stepwise rise with increasing severity of RAS. Age, duration of hypertension, estimated glomerular filtration rate, Gensini score, and multivessel disease were independent predictors for the presence of RAS. Hypertensive patients with those risk factors might need detailed investigation for RAS which may affect their prognosis.

Prevalence and predictors of renal artery stenosis in patients with coronary artery disease

Renal artery stenosis (RAS) is a strong independent predictor of mortality in patients with coronary artery disease (CAD). The study aimed to determine the prevalence of RAS in patients with significant CAD in order to develop and validate a score predicting RAS. Three hundred consecutive patients (50 females) with significant CAD underwent abdominal aortography following coronary angiography to screen for significant RAS defined as luminal narrowing of 50% or more. Univariate and multivariate analyses were performed comparing patients with and without RAS. Significant factors associated with RAS were included in constructing a score that predicts RAS. The score was internally validated in patients randomly selected from the entire study group (validation group; n = 103), using ROC curves and the Hosmer–Lemeshow goodness-of-fit test. Twenty-seven patients (9%) had a significant RAS. Multivariate analysis showed that age over 65 years (OR = 4.1%, 95% CI = 1.6-10.3, p = 0.003) and hypertension (OR = 3.1, 95% CI = 1.2–7.7, p = 0.015) were independent predictors of RAS. The predictive score including these two variables and three others (female gender, renal and insufficiency, and more than 2- or 3-vessel disease) ranged from 0 to 7. Internal validation showed a good performance (ROC curve = 0.79 and χ2 Lemeshow = 3.45). For a score of less than 2, the negative predictive value is 98%. The rate of significant RAS in patients with significant CAD was 9%. The performance of our predictive score was good, and significant reduction in the need to perform systematic abdominal aortography could be expected with the use of this score.

Prevalence and predictors of renal artery stenosis in hypertensive patients undergoing coronary angiography

Renal artery stenosis (RAS) is a major comorbid condition in patients with coronary artery disease (CAD). Although the reported prevalence of significant RAS among patients undergoing coronary angiography varies from 6.2 to 28% in Western countries, little information is available on the prevalence and predictors of RAS in Middle Eastern countries. From April 2007 to May 2008, 732 hypertensive patients with suspected CAD immediately after selective coronary angiography underwent abdominal aortography with or without selective renal angiography. Coronary angiography revealed stenosis of > or =50% in at least one of the main coronary vessels in 434 (59.3%) patients, including 100 (13.7%) cases with single-vessel CAD, 114 (15.6%) with two-vessel CAD and 220 (30.1%) with three-vessel CAD. Significant RAS was present in 87 patients (11.9%), severe (> or =75%) RAS in 35 patients (4.8%) and bilateral RAS in 37 patients (5.1%). Higher serum creatinine level, severity of CAD, history of coronary artery bypass graft surgery (CABG), congestive heart failure, and pulmonary edema together with atrial fibrillation were the most powerful predictors of significant RAS. In multivariate logistic regression analysis, three-vessel CAD (odds ratio 1.61, 95% confidence interval (1.36-1.91), P<0.001), history of CABG (odds ratio 4.40, 95% confidence interval (1.17-16.5), P=0.028) and serum creatinine level of >1.2 mg per 100 ml (odds ratio 2.12, 95% confidence interval (1.09-4.12), P=0.026) were the most powerful predictors of significant RAS. The prevalence of RAS in our patients was similar to that reported in the Western countries. The presence of multi-vessel CAD or a history of CABG along with a higher serum creatinine level in hypertensive patients undergoing coronary angiography was found to be a risk factor for RAS.

Frequency and predictors of renal artery stenosis in patients with coronary artery disease

Renal artery stenosis (RAS) remains underdiagnosed because of nonspecific clinical manifestations, including in patients with coronary artery disease (CAD). To estimate the prevalence and identify predictors of RAS in patients with CAD undergoing coronary angiography. University-based medical centre. We enrolled 650 consecutive patients (mean age=67+/-10 years, 80% men) with confirmed CAD. All patients underwent selective renal arteriography in the same procedure. We estimated the prevalence of RAS, defined as a >50% lesion. Multiple variable analysis of factors associated with presence of RAS was carried out using a logistic regression model. Variables that emerged as predictors by single-variable analysis were included in the model, along with variables that were tentatively associated with RAS, based on a literature review. RAS was detected in 94 patients (14.5%, 95% CI: 11.8-17.2%), including 20 (3.1%) with bilateral lesions. By single-variable analysis and presence and number of coronary artery stenoses (P<.001), hypertension (P=.001), and creatinine clearance <90 ml/min (P<.001) were associated with an increased risk of RAS. By multiple variable analysis, male sex (P<.05), presence and number of coronary artery lesions (P<.01), hypertension (P=.001), and renal insufficiency (P<.001) predicted the presence of RAS. The main clinical predictors of RAS in patients with CAD were hypertension, renal insufficiency, and multivessel CAD. These observations might help defining a high-risk subgroup of patients in need of meticulous investigations of both CAD and RAS.

Prevalence and Predictors of Renal Artery Stenosis in Hypertensive Patients Undergoing Elective Coronary Procedures

This study explored the prevalence and predictors of renal artery stenosis in a cohort of 525 hypertensive patients referred for elective coronary procedures. Patients underwent coronary and renal arteriography. The study defined renal artery stenosis as > or =60% luminal obstruction (physiologic or hemodynamic significance was not tested). Patients were classified into groups of those with normal renal arteries, those with insignificant renal artery stenosis, and individuals with significant renal artery stenosis. The mean age was 52.6+/-8.5 years, and 403 (76.8%) were males. Significant renal artery stenosis was found in 3.6%. It correlated significantly with hypertension duration (P=.005), history of cerebrovascular stroke (P=.01), history of angioplasty to >1 coronary vessel (P=.003), and 3-vessel coronary disease (P=.0003). Multivariate regression analysis identified 2-vessel and 3-vessel coronary artery disease as independent predictors of renal artery stenosis, with odds ratios of 4.9 and 12.1, respectively. It was concluded that invasive screening for renal artery stenosis was probably warranted only in hypertensive patients with multivessel coronary disease referred for elective coronary procedures.

Prevalence and predictors of renal artery stenosis in patients with coronary artery disease

Background Renal artery stenosis (RAS) is an important clinical entity that can lead to uncontrolled hypertension and progressive renal failure. The most common causes of RAS are atherosclerosis and fibromuscular dysplasia. Because the diagnosis of renovascular hypertension is established only when revascularization of a stenosed renal artery results in cure or improvement in patients hypertension, establishment of a causal relationship between RAS and hypertension continues to present a challenge. Therefore, a high index of suspicion is essential in the diagnosis of this condition. Methods Multiple tests, both invasive and noninvasive, are available as screening methods. Angiography remains the gold standard for diagnosis of RAS. Besides its value in establishing the diagnosis, it provides anatomic information regarding the site and severity of stenoses and appropriate revascularization strategies. Magnetic resonance angiography and duplex ultrasonography are the most promising and accurate noninvasive screening tests available, even in the presence of renal insufficiency. With advances in percutaneous transluminal angioplasty techniques, including renal artery stenting, many more patients are eligible for less invasive and effective revascularization strategies compared with the traditional surgical procedures. Results Revascularization of a stenosed renal artery is associated with preservation of renal function and better control of hypertension, unstable angina, and congestive heart failure. Because atherosclerotic RAS is associated with generalized atherosclerosis, aggressive risk factor modification and antiplatelet therapy are integral in the management of RAS regardless of the revascularization strategy. (Am Heart J 2002;143:559-64.)

Prevalence and prediction of renal artery stenosis in patients with coronary and supraaortic artery atherosclerotic disease

Renal atherosclerosis is associated with increased cardiovascular mortality. This study aimed to determine the prevalence and predictors of renal artery stenosis (RAS) in patients with coronary artery disease (CAD) and supraaortic arteries (SA) stenosis. Renal angiography was performed in 1193 (807 men) consecutive patients referred for coronary or SA angiography. Group I included 296 (136 men, 60.1 +/- 9.5 years) patients with no significant (< 50%) lesion in coronary arteries or SA; group II included 706 (526 men, 62.2 +/- 9.7 years) patients with stenosis > or = 50% within single arterial territory (coronary arteries or SA) and group III included 191 (145 men, 64.9 +/- 8.5 years) patients with stenosis > or = 50% in both territories. Some RAS was found in 55 (18.6%) patients in group I, 250 (35.4%) patients in group II and 115 (60.2%) patients in group III (P < 0.001). The proportion of patients with RAS > or = 50% in groups I, II and III was 3.3, 6.2 and 18.3%, respectively (P < 0.001). RAS prevalence increased with the number of stenosed coronary arteries (38.4% in 1-vessel, 42.1% in 2-vessel, 48.5% in 3-vessel CAD, P < 0.001). Independent predictors of RAS > or = 50% identified by logistic regression analysis were SA stenosis [relative risk (RR) = 3.28, P < 0.001], 2-3-vessel-CAD (RR = 2.04, P = 0.002), creatinine level > or = 1.07 mg/dl (RR = 2.95, P < 0.001), hypertension (RR = 2.97, P = 0.012) and body mass index < 25 kg/m(2) (RR = 1.42, P = 0.169). A calculated score for RAS > or = 50% prediction (based on the regression model) was reliable (coefficient of determination, R = 0.978) and showed a sensitivity of 77.5% and a specificity of 63.9%. RAS prevalence and severity increases with the number of arterial territories involved and CAD severity. The following independent predictors of RAS > or = 50% were identified: SA involvement, 2-3-vessel-CAD, serum creatinine level and hypertension.

Prevalence and predictors of renal artery stenosis in patients with coronary artery disease

Prevalence and predictors of renal artery stenosis in patients with coronary artery disease

Prevalence of renal artery stenosis in high-risk veterans referred to cardiac catheterization.

The prevalence of atherosclerotic renal artery stenosis (RAS) varies depending on patient selection with no specific guidelines on indications for selective renal angiography in patients referred for coronary angiography. The goal of this study is to determine the prevalence and predictors of renal artery stenosis in hypertensive veterans referred for coronary angiography. Prospective study. Tertiary care veterans' administration facility in the USA. A total of 90 veterans referred for coronary angiography with an initial ascending aortic pressure > 135 mmHg. Selective renal angiography was performed following coronary angiography. We found that 28% of the patients had single RAS (> or = 50% stenosis), while 16% had single RAS > or = 70% stenosis, 10% had bilateral RAS >or = 50% and 6% had bilateral RAS > or = 70%. Significant positive univariate predictors of RAS (> or = 50%) were age, peripheral vascular disease (PVD), creatinine level (Cr) and myocardial infarction. Significant multivariate predictors of RAS (> or = 50%) were age > 65 years [relative risk (RR), 3.6; 95% confidence interval (CI), (1.2-10.6)], PVD [RR 3.2, 95% CI (1.1-9.1)] and Cr > 1 mg/dl [RR 4.9, 95% CI (1.53-15.9)]. No complications related to renal angiography were noted. Selective renal angiography during routine coronary angiography in hypertensive veterans with coronary artery disease is safe and uncovers RAS in many older patients with PVD and renal insufficiency.

Prevalence and Outcome of Renal Artery Stenosis in Atherosclerotic Patients with Renal Dysfunction.

We investigated the prevalence of renal artery disease and outcome in a cohort of atherosclerotic patients with renal dysfunction. We studied 44 consecutive patients who were older than 50 years of age, who had renal dysfunction and in whom one or more of the following atherosclerotic diseases was confirmed: cerebral infarction, coronary artery disease or peripheral vascular disease. Renal artery stenosis was assessed by gadolinium-enhanced magnetic-resonance angiography. Patients who were treated medically were prospectively followed up in our outpatient clinic and the impact of renal artery stenosis on survival was evaluated. Renal artery stenosis was found in 22 (50%) of the 44 patients. Difference in kidney length and carotid artery stenosis were identified as independent predictors of renal artery stenosis. Among the patients who were treated medically (n=42), rates of mortality were 4.4, 12.7 and 18.1 per 100 patient-years in those without renal artery stenosis, those with unilateral renal artery stenosis and those with bilateral renal artery stenosis, respectively. The mortality and renal survival curves were significantly different among these three groups. These findings indicate that renal artery stenosis is common in patients with renal dysfunction and concomitant cardiovascular disease, especially in those with carotid artery stenosis, and that a substantial difference in the length of kidneys may be a predictor of renovascular disease. Patients with renal dysfunction resulting from renal artery stenosis are at risk of death from cardiovascular disease and end-stage renal failure.

Prevalence and predictors of renal artery stenosis in patients undergoing cardiac catheterization.

Renal artery stenosis (RAS) is recognized as a major co-morbid condition for patients with cardiovascular disease. Although the prevalence of RAS in Western countries has been reported as 13.5-18% in patients with suspected coronary artery disease (CAD) undergoing coronary angiography, there is little information available about the prevalence of RAS in Asian populations, which are less susceptible to atherosclerosis. To evaluate the prevalence of RAS in Japanese patients suspected of cardiovascular disease and the relationships among RAS and vascular risk factors, especially hypertension, renal artery angiography was performed in a total of 289 consecutive patients receiving diagnostic cardiac catheterization. RAS with a stenosis diameter greater than 50% was considered significant. The prevalence of RAS was 21/289 (7%) including 18 (6%) cases of unilateral stenosis and 3 (1%) of bilateral stenosis. RAS accompanied 14/220 (6%) cases of CAD, 4/34 (12%) cases of valvular heart disease and 1/14 (7%) cases of cardiomyopathy. In the subgroups of CAD, the prevalence of RAS was 5%, 10%, 9%, and 19% in cases of 0, 1, 2 and 3-vessel disease, respectively. Hypertension was more frequent among patients with than among those without RAS (86% vs. 45%, p=0.0003). The prevalence of RAS was 13% in hypertensives and 2% in normotensives (p = 0.004). Thus RAS was frequent in patients with established CAD, and particularly in those with 3-vessel disease. Together, the results showed that hypertension was closely associated with RAS, appearing as both a risk factor and a possible clinical manifestation of the disease. We conclude that more attention should be paid to RAS in Japanese patients with hypertension and cardiovascular disease.

Renal artery stenosis in minority patients undergoing diagnostic cardiac catheterization: prevalence and risk factors.

Atherosclerotic renal artery stenosis (RAS) is a frequently overlooked clinical entity that can cause progressive renal failure and uncontrolled hypertension. Revascularization of a stenosed renal artery is associated with improved clinical outcomes including the prevention of renal failure. Thus, it is important to recognize all potential candidates for renal artery revascularization. In a general population referred for diagnostic cardiac catheterization, RAS of any severity was found in 30% of patients and significant stenosis (> or = 50% diameter narrowing) was found in 15% of patients. The number of minority groups is increasing in the US population, and RAS in this population is not well investigated. Our purpose was to determine the prevalence and risk factors associated with RAS in minority patients referred for diagnostic cardiac catheterization. Abdominal aortography was performed in 171 consecutive minority patients referred for diagnostic cardiac catheterization (hispanics = 115, African Americans = 56). The association of clinical and angiographic variables with RAS was examined using univariate and multivariate logistic regression analyses. Renal artery stenosis of any severity was identified in 13.5% of patients (unilateral 7.7%, bilateral 5.8%). Significant RAS was found in 7.7% of patients (unilateral 4.8%, bilateral 2.9%). Independent predictors of RAS included age (mean +/-1SD, 68 +/-10 vs 57 +/-12 yr, P < 0.001, for patients with vs without RAS), coronary artery disease, and elevated serum creatinine levels (> 115 micromol/L). Race/ethnicity (hispanics vs African Americans), sex, smoking, congestive heart failure, diabetes mellitus, peripheral vascular disease, and hypertension were not independent predictors. Renal artery stenosis in minority patients undergoing diagnostic cardiac catheterization is less common than reported in white patients, is similar in hispanics and African Americans, and is similar in women and men. The clinical and angiographic features are helpful in predicting its presence.

Prevalence of Renal Artery Stenosis in Autopsy Patients With Stroke

Atherosclerotic renal artery stenosis commonly exists as one manifestation of more generalized atherosclerosis. It is a progressive but potentially curable disorder. Thus, information on renal artery involvement in atherosclerotic diseases could be important. We investigated the prevalence of renal artery stenosis in autopsied patients with stroke over 40 years of age. From 2167 consecutive autopsy patients who died between 1980 and 1997, we studied 346 cases of mean age of 69+/-11 years with clinical evidence of stroke. Atherosclerotic renal artery stenosis (>/=75% luminal area narrowing) was found in 36 patients (10.4%). Patients with renal artery stenosis were older and had worse renal function. Renal artery stenosis was found in 14.7%, 28.6%, and 23.9% of patients with hypertension, renal insufficiency, and aortic aneurysm, respectively. Extracranial carotid artery stenosis (>50% luminal area narrowing) was found in 101 patients (29.2%). Of the 346 stroke patients, 256 had a history of brain infarction. In patients with brain infarction, renal artery stenosis was found in 31 (12.1%) and carotid stenosis was found in 81 (33.6%). Patients with carotid artery stenosis were more likely to have renal artery stenosis than patients without carotid artery stenosis (24.4% versus 5.9%, P<0.0001). Multiple logistic regression analysis identified renal insufficiency, hypertension, female gender, and presence of carotid artery stenosis as independent predictors of renal artery stenosis in patients with brain infarction. These data reveal that atherosclerotic renal artery stenosis is common in patients with stroke, especially in those with brain infarction.

The prevalence and associated risk factors of renal artery stenosis in patients undergoing cardiac catheterization.

Renal artery stenosis may be a cause of hypertension and a potential contributor to progressive renal insufficiency. However, the prevalence of renal artery disease in a general population is poorly defined. The purposes of this study were to evaluate the prevalence of angiographically-determined renal artery narrowing in a patient population undergoing routine cardiac catheterization, and to identify the risk factors for renal artery stenosis. After left ventriculography, abdominal aortography was performed to screen for the presence of renal artery stenosis. A total of 427 patients (274 males, 153 females) were studied and the mean age was 59 years. Renal artery narrowing was identified in 10.5% of patients. Significant (> or = 50% diameter narrowing) renal artery stenosis was found in 24 patients (5.6%) and insignificant stenosis was found in 21 patients (4.9%). Significant unilateral stenosis was present in 4.2% of patients and bilateral stenosis was present in 1.4%. The stem of the renal artery was a more common site of stenosis in 62.2% of patients than in the ostium (37.8%), but the severity of stenosis was not significantly different according to the site of stenosis. By univariate and multivariate logistic regression analysis, the association of clinical variables with renal artery stenosis was assessed. Multivariable predictors included age, hypertension and peripheral vascular disease (p < 0.05). The variables such as sex, smoking history, hyperlipidemia, renal insufficiency, as well as the presence of obesity, severity of coronary heart disease and D.M., were not associated. In conclusion, the prevalence of angiographically-determined renal artery narrowing in a patient population undergoing cardiac catheterization is 10.5%. Old age, hypertension and evidence of peripheral vascular disease represent the predictors of renal artery stenosis.

Prevalence and Predictors of Renal Artery Stenosis in Patients With Myocardial Infarction

In recent years, the importance of renovascular disease as a cause of end-stage renal disease has been emphasized. Among 1,788 cases autopsied during the 12-year period between 1981 and 1992 at the National Cardiovascular Center Hospital, we examined cases over 40 years of age with autopsy evidence of myocardial infarction to determine the prevalence and predictors of atherosclerotic renal artery stenosis in the atherosclerotic population. Two hundred ninety-seven patients remained for analysis. In this population, atherosclerotic renal artery stenosis was found in 35 patients (12%), and 10 of them had bilateral renal artery stenosis. In patients with hypertension, proteinuria, and renal insufficiency, renal artery stenosis was found in 19%, 39%, and 39%, respectively. As the number of coronary vessels with significant stenosis increased, the prevalence of renal artery stenosis increased. The severity of stenotic lesions of coronary artery was also correlated with the presence of renal artery stenosis. Multiple logistic regression analysis identified age, hypertension, proteinuria, and renal insufficiency as independent predictors of renal artery stenosis. Patients with hypertension, proteinuria, and renal insufficiency had 3.4-, 13.5-, and 4.8-fold increased risk of renal artery stenosis in the population with myocardial infarction. The number of coronary arteries with severe stenosis was also an independent predictor of renal artery stenosis, and had a relative risk of 2.1. These results indicated that atherosclerotic renal artery stenosis is common in patients with myocardial infarction, particularly when hypertension, proteinuria, or renal insufficiency is present. The presence of severe multivessel coronary artery disease suggests a higher incidence of renal artery stenosis.