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Minerva Urologica e Nefrologica 2003 September;55(3):185-92


language: English

Atherosclerotic ischemic renal disease

Moscaritolo E. 1, Coen G. 1, Calabria S. 1, Lai S. 2, Nofroni I. 3, Rossi M. 5, Ventroni G. 4, Sardella D. 1, Zaccaria A. 6, Cianci R. 2

1 Renal Pathophysiology and Hypertension Unit, Chair of Nephrology “La Sapienza” University, Rome, Italy 2 VI Medical Clinic “La Sapienza” University, Rome, Italy 3 Department of Experimental Medicine and Pathology “La Sapienza” University, Rome, Italy 4 Nuclear Medicine Unit “La Sapienza” University, Rome, Italy 5 II Chair of Radiology “La Sapienza” University, Rome, Italy 6 Chair of Vascular Surgery “La Sapienza” University, Rome, Italy


Aim. Atherosclerotic is­chem­ic re­nal dis­ease is a fre­quent ­cause of end-­stage re­nal fail­ure lead­ing to di­al­y­sis ­among the eld­er­ly; its prev­a­lence is in­ferred ­from au­top­sy or ret­ro­spec­tive ar­te­ri­o­graph­ic stud­ies. Screening in­ves­ti­ga­tion for is­chem­ic neph­rop­a­thy on ­large co­horts, ­based on non in­va­sive di­ag­nos­tic tech­niques, ­have not so far ­been pub­lished. This ­study has ­been con­duct­ed on 269 sub­jects ­over 50 ­with hy­per­ten­sion and/or chron­ic re­nal fail­ure, un­re­lat­ed to oth­er ­known caus­es of re­nal dis­ease.
Methods. All 269 pa­tients ­were stud­ied ei­ther by col­or-­flow du­plex so­nog­ra­phy (n=238) or by re­nal scin­tig­ra­phy (n=224), and 199 of the 269 pa­tients ­were eval­u­at­ed us­ing ­both of ­these tech­niques. Forty pa­tients, ­found to ­have re­nal ar­tery sten­o­sis, ­were sub­ject­ed to 3D-con­trast en­hance­ment magnetic resonance angiography (MRA) and/or digital selective angiography (DSA). An ad­di­tion­al 23 cas­es, neg­a­tive ­both to scin­tig­ra­phy and to ultra­sound ­study, under­went re­nal an­gio­gra­phy (MRA and/or DSA).
Results. Color-du­plex so­nog­ra­phy, car­ried out in 238 pa­tients, re­vealed 49 cas­es of re­nal ar­tery sten­o­sis. MR or DSA was car­ried out in 35 of ­these 49 pa­tients, and con­firmed the di­ag­no­sis in 33. Color-du­plex so­nog­ra­phy was 91.7% sen­si­tive and 90.9% spe­cif­ic, ­with pos­i­tive pre­dic­tive val­ue of 94.2% and neg­a­tive pre­dic­tive val­ue of 86.9%. Specificity and sen­si­tiv­ity of re­nal scin­tig­ra­phy, car­ried out in 224 pa­tients, was sig­nif­i­cant­ly low­er. Patients ­with re­nal ar­tery sten­o­sis ­showed a high­er de­gree of re­nal in­suf­fi­cien­cy com­pared to non ste­not­ic pa­tients ­while ­there ­were no dif­fer­enc­es in the ex­tent of pro­tei­nu­ria ­between the two ­groups. Renal ar­tery sten­o­sis, ­based on col­or-du­plex so­nog­ra­phy stud­ies, was ­present in 11% of pa­tients in the age ­group 50-59, 18% in the 60-69 and 23% at age 70 and ­above.
Conclusion. A rel­a­tive­ly ­large per­cent­age of the eld­er­ly pop­u­la­tion ­with re­nal in­suf­fi­cien­cy and/or hy­per­ten­sion is af­fect­ed by re­nal ar­tery sten­o­sis and is at ­risk of de­vel­op­ing end-­stage re­nal fail­ure. Color-du­plex ultra­so­nog­ra­phy is a val­id rou­tine meth­od of in­ves­ti­ga­tion of pop­u­la­tion at ­risk for re­nal ar­tery sten­o­sis.

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