Atherosclerotic renovascular disease (ARVD) is a common condition which presents with acute or chronic renal failure, hypertension or cardiac failure. Its prevalence is high in the elderly and in those with evidence of generalised vascular disease. It is therefore common in diabetic patients, who are prone to development of generalised atherosclerotic vascular disease. The majority of diabetic patients have clinical indications that merit angiotensin-converting enzyme (ACE) inhibitor or angiotensin II receptor antagonist (AIIA) therapy, but even if ARVD is present, acute renal dysfunction will be the exception rather than the rule. Certain clinical clues should instigate a high index of suspicion for the presence of ARVD in the diabetic patient, but it does not follow that detection of anatomically significant stenoses within the renal arteries should automatically be treated by renal revascularisation. The results of Angioplasty and Stent for Renal Artery Lesions (ASTRAL), a UK multi-centre study, should hopefully guide appropriate practice in this area in the future.
Choudhri AH, Cleland JG, Rowlands PC, Tran TL, McCarthy M., Al-Kutoubi MAUnsuspected renal artery stenosis in peripheral vascular disease. BMJ1990;301:1197-8.
2.
Harding MB, Smith LR, Himmelstein SI et al. Renal artery stenosis. Prevalence and associated risk factors in patients undergoing routine cardiac catherization. J Am Soc Nephrol1992;2:1608-16.
3.
Olin JW, Melia M., Young JR, Graor RA, Risius B.Prevalence of atherosclerotic renal artery stenosis in patients with atherosclerosis elsewhere. Am J Med1990;88:46N-51N.
4.
Zuccala A., Losinno F., Zuchelli A., Zuchelli PCRenovascular disease in diabetes mellitus: treatment by percutaneous transluminal renal angioplasty. Nephrol Dial Transplant1998;13:26-9.
5.
Valabhji J., Robinson S., Poulter C. et al. Prevalence of renal artery stenosis in subjects with type 2 diabetes and coexistent hypertension. Diabetes Care2000;23:539-43.
6.
Courreges JP , Bacha J., Aboud E., Pradier P.Prevalence of renal artery stenosis in type 2 diabetes. Diabetes Metab2000;26:90-6.
7.
Lewis EJ, Hunsicker LG, Bain RP, Rohde RDThe effect of angiotensin converting enzyme inhibition on diabetic nephropathy . N Engl J Med1993;329:1456-62.
8.
The EUCLID Study Group.Randomised placebo-controlled trial of lisinopril in normotensive patients with insulin-dependent diabetes and normoalbuminuria or microalbuminuria. Lancet1997;349:1787-92.
9.
The Microalbuminuria Captopril Study Group.Captopril reduces the risk of nephropathy in IDDM patients with microalbuminuria. Diabetologia1996;39:587-93.
10.
Brenner BM, Cooper ME, de Zeeuw D. et al., for the RENAAL Study Investigators.Effects of losartan on renal and cardiovascular outcomes in patients with type 2 diabetes and nephropathy. N Engl J Med2001; 345:861-9.
11.
Lewis EJ, Hunsicker LG, Clarke WR et al., for The Collaborative Study Group. Renoprotective effect of the angiotensin-receptor antagonist irbesartan in patients with nephropathy due to type 2 diabetes. N Engl J Med2001;345:851-60.
12.
Pitt B., Segal R., Martinez M. et al., on behalf of Elite study investigators.Randomised trial of lorsartan versus captopril in patients over 65 with heart failure. (Evaluation of Lorsartan in the Elderly Study, ELITE) . Lancet1997;349:747-52.
Kalra PA, Kumwenda M., MacDowall P., Roland MOACE inhibitor usage and monitoring in general practice: the need for guidelines to prevent renal failure. BMJ1999 ;318:234-7.
15.
Kshirsagar AV, Joy MS, Hogan SL, Falk RJ, Colindres REEffect of ACE inhibitors in diabetic and nondiabetic chronic renal disease: a systematic overview of randomized placebo-controlled trials. Am J Kidney Dis2000; 35:695-707.
16.
Conlon PJ, O'Riordan E., Kalra PANew insights into the epidemiologic and clinical manifestations of atherosclerotic renovascular disease. Am J Kidney Dis2000 ;35:573-87.
17.
Schreiber MF , Pohl MA, Novick ACThe natural history of atherosclerotic and fibrous renal artery disease. Urol Clin North Am1984;11:383-92.
18.
Zierler RE, Bergelin RO, Isaacson JA, Strandness DE Jr.Natural history of atherosclerotic renal artery stenosis: a prospective study with duplex ultrasonography. J Vasc Surg1994 ;19:250-8.
19.
Caps MT, Zierler RE, Polissar NL et al. Risk of atrophy in kidneys with atherosclerotic renal artery stenosis. Kidney Int1998;53:735-42.
20.
Textor SCRevascularisation in atherosclerotic renal artery disease. Kidney Int1998;53:799-811.
21.
Bonelli FS, McKusick MA, Textor SC et al. Renal artery angioplasty: technical results and clinical outcome in 320 patients. Mayo Clinic Proc1995; 70:1041-52.
22.
Harden PN, MacLeod MJ, Rodger RSC et al. Effect of renal artery stenting on progression of renovascular renal failure. Lancet1997;349:1133-6.
23.
Hallett JW, Textor SC, Kos PB et al. Advanced renovascular hypertension and renal insufficiency: trends in medical comorbidity and surgical approach from 1970 to 1993. J Vasc Surg1995;21:750-9.
24.
Suresh M., Laboi P., Mamtora H., Kalra PARelationship of renal dysfunction to proximal arterial disease severity in atherosclerotic renovascular disease. Nephrol Dial Transplant2000;15:631-6.
25.
Pickering TG , Herman L., Devereux RB et al. Recurrent pulmonary oedema in hypertension due to bilateral renal artery stenosis: treatment by angioplasty or surgical revascularisation. Lancet1988;ii(8610):551-2.
