Natural History Of Atherosclerotic Renal Artery Stenosis

Abstract

The primary goal of natural history studies on renal artery atherosclerosis is to document the rates and risk factors for disease progression to provide a basis for clinical decision-making. Since serial follow-up is required, renal duplex scanning is ideally suited for this type of clinical investigation. In the University of Washington study, about one-third of all renal arteries showed progression of disease over time, with higher progression rates among arteries with more severe degrees of stenosis. Risk factors associated with progression included increased systolic blood pressure, diabetes mellitus, and a low ankle-arm index. Significant renal atrophy was associated with systolic hypertension, severe renal artery stenosis, and decreased renal parenchymal blood flow There was also a correlation between renal atrophy and increases in serum creatinine. Patients with renal artery atherosclerosis had a relatively high incidence of end-stage renal disease, myocardial infarction, stroke, and death. These data indicate that risk factor management—particularly control of systolic hypertension—is a critical issue in this patient population. Although the results of this natural history study suggest that early renal revascularization could be beneficial for selected patients with renal artery stenosis, the effect of such intervention on clinical outcome must still be established.