Atherosclerotic Renal Artery Stenosis: Association with Emerging Vascular Risk Factors

Abstract

Background: The established risk factors for atherosclerotic renal artery stenosis (ARAS) include hypertension, diabetes mellitus, dyslipidemia, obesity,smoking, old age and family history. In the last few years, several emerging risk factors have been proposed as predictors of ARAS, namely homocysteine, fibrinogen, C-reactive protein, lipoprotein(a) and creatinine. Methods: We searched Pubmed/Medline for studies investigating the prognostic value of each of these emerging risk factors in ARAS. Results: Creatinine and C-reactive protein seem to be the most promising predictors of ARAS, whereas the prognostic value of homocysteine, lipoprotein(a) and fibrinogen is not yet fully determined. Conclusion: The establishment of a definite role for these emerging risk factors could result in earlier recognition and/or better management of ARAS with potential regression/slowing down of progression of stenosis. Modifying these markers may also improve the therapeutic approach of the associated systemic atherosclerosis in these high-risk patients. Future trials should focus on the effect of different classes of drugs (e.g. statins and fibrates) on the levels of the emerging risk factors and the association with ARAS progression.

The Evaluation of Clinical Signs in Patients with Suspected Renovascular Hypertension

“…Some studies show that the smoking habit is a risk factor for atherosclerotic RAS (4,9). Smoking in our patient population was not detected as a risk factor for RAS.…”

“…Various results have been reported regarding the relationship between BMI and RAS. In one study, obesity was shown as a risk factor for atherosclerotic RAS (9). Other studies have reported that low BMI is a risk factor for RAS (3,4).…”

“…In different studies by Park, Krijnen and Paraskevas, hyperlipidemia has been shown to be a clinical marker for RAS (4,9,17). Hansen et al showed low HDL to be an independent risk factor (8).…”

“…In various studies, an increased level of plasma creatinine has been shown to be a powerful marker for RAS (1,3,9,20). Uzu et al found that 39% of patients with renal failure had RAS (18).…”

“…The prevalence of RVH varies with the clinical settings. It is about 1-5% in all the hypertensive population, less than 1% in patients with mild-moderate high blood pressure, and between 10-45% in patients with severe, malignant or resistant hypertension (1)(2)(3)(4)(5)(6)(7)(8)(9)(10) Although renal angiography is the gold standard for the diagnosis of RAS, it is an invasive and costly method. Due to the risks associated with contrast nephropathy, angiography is recommended for patients at high risk for RVH (1,4).…”