Prospective Study of Atherosclerotic Disease Progression in the Renal Artery

Abstract

Background-The aim of this study was to determine the incidence of and the risk factors associated with progression of renal artery disease in individuals with atherosclerotic renal artery stenosis (ARAS). Methods and Results-Subjects with Ն1 ARAS were monitored with serial renal artery duplex scans. A total of 295 kidneys in 170 patients were monitored for a mean of 33 months. Overall, the cumulative incidence of ARAS progression was 35% at 3 years and 51% at 5 years. The 3-year cumulative incidence of renal artery disease progression stratified by baseline disease classification was 18%, 28%, and 49% for renal arteries initially classified as normal, Ͻ60% stenosis, and Ն60% stenosis, respectively (Pϭ0.03, log-rank test). There were only 9 renal artery occlusions during the study, all of which occurred in renal arteries having Ն60% stenosis at the examination before the detection of occlusion. A stepwise Cox proportional hazards model included 4 baseline factors that were significantly associated with the risk of renal artery disease progression during follow-up: systolic blood pressure Ն160 mm Hg (relative risk [RR]ϭ2.1; 95% CI, 1.2 to 3.5), diabetes mellitus (RRϭ2.0; 95% CI, 1.2 to 3.3), and high-grade (Ͼ60% stenosis or occlusion) disease in either the ipsilateral (RRϭ1.9; 95% CI, 1.2 to 3.0) or contralateral (RRϭ1.7; 95% CI, 1.0 to 2.8) renal artery. Conclusions-Although renal artery disease progression is a frequent occurrence, progression to total renal artery occlusion is not. The risk of renal artery disease progression is highest among individuals with preexisting high-grade stenosis in either renal artery, elevated systolic blood pressure, and diabetes mellitus. (Circulation. 1998;98:2866-2872.)

Regression of atherosclerotic renal artery stenosis with aggressive lipid lowering therapy

“…In patients with normal or less than 60% stenosis of the renal artery, the 3-year cumulative incidence of progression to over 60% stenosis and occlusion is approximately 50-60% and 5-7% respectively. 6,7 The advancement of such stenotic lesions in renal arteries occurs despite the use of antihypertensive medication and is increasingly recognised as an important cause of end-stage renal failure. 8 Recently, restoration of vessel patency by balloon angioplasty has been shown to reduce the need for antihypertensive medication 9 and also to delay the progression of renal failure.…”

Atherosclerotic renovascular disease and renal impairment: Can we predict the effect of intervention?

“…In another report, the 3-year cumulative incidence of progression, defined as any detectable increase in the degree of diameter reduction affecting at least one renal artery, was 35% [29]. In a stepwise Cox proportional hazard analysis, baseline risk factors associated with progression were a systolic blood pressure of at least 160 mm Hg, diabetes mellitus, and high-grade ( 60% stenosis, or occlusion) ipsilateral or contralateral stenosis [29]. Thus far, the available randomized controlled trials focused on the effect of PTRA (on top of medical therapy) versus medical therapy alone on blood pressure [25][26][27].…”

“…Renal artery occlusion occurred in 28 cases (14%). In another report, the 3-year cumulative incidence of progression, defined as any detectable increase in the degree of diameter reduction affecting at least one renal artery, was 35% [29]. In a stepwise Cox proportional hazard analysis, baseline risk factors associated with progression were a systolic blood pressure of at least 160 mm Hg, diabetes mellitus, and high-grade ( 60% stenosis, or occlusion) ipsilateral or contralateral stenosis [29].…”

Recovery of normal diurnal variation of blood pressure following renal artery stenting

“…1 The ostium and proximal third of the renal artery is typically involved, although advanced disease can cause diffuse involvement including the intrarenal segments. 2 Nocturnal dip in BP during sleep is a normal phenomenon. The loss of the nocturnal dip in hypertensives detects a subgroup at greater risk of target organ damage and subsequent major cardiovascular events.…”