Renovascular disease in older patients beginning renal replacement therapy

Abstract

Renovascular disease (RVD) in older patients can cause progressive renal insufficiency and even end-stage renal disease (ESRD). The frequency of this clinical problem is not well defined. Renal duplex sonography (RDS) correctly identifies the presence of RVD with an overall accuracy of approximately 95%. Therefore, the purpose of this study was to utilize RDS as a noninvasive tool to identify the presence of critical RVD (> or = 60% diameter-reducing stenosis or occlusion) in patients 50 years of age or older beginning renal replacement therapy. A total of 53 consecutive participating patients were prospectively interrogated. Complete interrogations occurred in 45 of the 53 patients (85%), and 92 of the 103 kidneys (89%). Critical RVD was noted in 10 of 45 patients (22%). RVD was bilateral in 5 patients, unilateral in 5 patients, and there were 4 renal artery occlusions noted. All patients with critical RVD were white (10 of 25 white patients or 40%). Total pack years of smoking as well as associated cardiovascular and cerebrovascular conditions were greater in those patients with critical RVD compared to those without. These results indicate that RDS remains technically feasible as renal blood flow and function decline. Unsuspected RVD possibly contributory to renal insufficiency exists in a significant number of primarily white patients 50 years of age or older beginning renal replacement therapy. These patients are generally smokers with a high frequency of associated extrarenal atherosclerosis The addition of RVD as a separate category of disease causing ESRD would improve U.S. Renal Data System ESRD classification. RVD should be recognized as a cause of ESRD.

Smoking and the Kidney

“…The prevalence of renal vascular stenosis is higher in patients with peripheral vascular disease (59). The latter is common in smokers; it is not therefore surprising that smokers have a higher risk of critical atherosclerotic renal artery stenosis (60,61). As one would expect, a high proportion of patients with unilateral (62) or bilateral (63) atherosclerotic renal artery stenosis are smokers.…”

Cocaine Use and Hypertensive Renal Changes in HIV-Infected Individuals

“…In hypertensive individuals, smoking is an independent risk factor for development of microalbuminuria. Furthermore, smoking has been associated with the progression of lupus nephritis (45), renal artery stenosis (46), and renal tubular dysfunction (47).…”

Atherosclerotic Renovascular Disease

“…According to a recent administrative data regarding general population of the elderly greater than 65 years of age in the United States, the prevalence and incidence rates of ARVD were estimated 0.5% and 3.7 per each 1000 person-years respectively (Kalra et al, 2005). In addition, some epidemiological researches demonstrated that the prevalence among those with end-stage renal disease beginning renal replacement therapy was estimated from 5% to 22% (Rimmer & Gennari, 1993;Mailloux et al, 1994;Appel et al, 1995;van Ampting et al, 2003). Of note, ARVD is not only responsible to impaired kidney function but also reflects a status of patients at risk for systemic cardiovascular diseases (Kalra et al, 2005).…”