Skip Navigation

European Heart Journal 2002 23(21):1684-1691; doi:10.1053/euhj.2002.3314
Copyright © 2002 by the European Society of Cardiology.
This Article
Right arrow Abstract Freely available
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in ISI Web of Science
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My Personal Archive
Right arrow Download to citation manager
Right arrow Search for citing articles in:
ISI Web of Science (34)
Right arrowRequest Permissions
Google Scholar
Right arrow Articles by Weber-Mzell, D.
Right arrow Articles by Skrabal, F.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Weber-Mzell, D.
Right arrow Articles by Skrabal, F.
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us  
What's this?

Coronary anatomy predicts presence or absence of renal artery stenosis. A prospective study in patients undergoing cardiac catheterization for suspected coronary artery disease

D. Weber-Mzella, P. Kotankoa,f1, M. Schumacherb, W. Kleinb and F. Skrabala

a Krankenhaus der Barmherzigen Brüder, Teaching Hospital of the Karl Franzens University Graz, Department of Internal Medicine, Graz, Austria
b University Clinic Internal Medicine, Department Cardiology, Graz, Austria

revised May 28, 2002; accepted May 29, 2002

Abstract

Aims This study aimed to determine the prevalence of renal artery stenosis (RAS) and associated risk factors in patients undergoing cardiac catheterization for suspected coronary artery disease (CAD).

Methods One hundred and seventy-seven consecutive patients (62 females) with a serum creatinine concentration <2·0mg.dl–1 were studied. Abdominal aortography followed cardiac catheterization to screen for RAS.

Results In 110 patients (62%) CAD and in 19 patients (11%) significant RAS (luminal narrowing of ≥50%) were detected, 12 of whom had high grade (≥70%) RAS, and two subjects had significant RAS without CAD. Patients with RAS were older (67±8 vs 61±11 years, mean±SD;P =0·004), had higher systolic blood pressure (150±15 vs 138±20mmHg;P =0·005), a lower glomerular filtration rate (GFR; 61±16 vs 80±22ml.min–1, P<0·001) and more often diabetes mellitus (69% vs 30%; P=0·004). In multivariate analysis a low GFR and the extent of CAD were independent predictors of RAS. The presence of >2 significant coronary lesions predicted RAS (sensitivity 0·84, specificity 0·77, positive predictive value 0·30, negative predictive value 0·98).

Conclusion Screening for RAS in patients with >2 diseased coronary segments has a high diagnostic yield, which is even greater in the presence of a reduced GFR, diabetes mellitus, and elevated systolic blood pressure.Copyright 2002 The European Society of Cardiology. Published by Elsevier Science Ltd. All rights reserved .

Key Words: Renal artery stenosis, coronary artery disease, cardiac catheterization, ROC analysis.

f1 Correspondence: Peter Kotanko, MD, Krankenhaus der Barmherzigen Brüder, Teaching Hospital of the Karl Franzens University Graz, Department of Internal Medicine, Marschallgasse 12, A-8020 Graz, Austria.

References

  1. Foster JH, Dean RH, Pinkerton JA, Rhamy RK. Ten years experience with the surgical management of renovascular hypertension. Ann Surg. 1973;177:755–766[ISI][Medline]
  2. Valabhji J, Robinson S, Poulter C. Prevalence of renal artery stenosis in subjects with type 2 diabetes and coexistent hypertension. Diabetes Care. 2000;23:539–543[Abstract]
  3. Missouris CG, Buckenham T, Cappuccio FP, MacGregor GA. Renal artery stenosis: a common and important problem in patients with peripheral vascular disease. Am J Med. 1994;96:10–14[CrossRef][ISI][Medline]
  4. Olin JW, Melia M, Young JR, Graor RA, Risius B. Prevalence of atherosclerotic renal artery stenosis in patients with atherosclerosis elsewhere. Am J Med. 1990;88:46N–51N[CrossRef][Medline]
  5. Appel RG, Bleyer AJ, Reavis S, Hansen KJ. Renovascular disease in older patients beginning renal replacement therapy. Kidney Int. 1995;48:171–176[ISI][Medline]
  6. Harding MB, Smith LR, Himmelstein SI. Renal artery stenosis: prevalence and associates risk factors in patients undergoing routine cardiac catheterization. J Am Soc Nephrol. 1992;2:1608–1616[Abstract]
  7. Vetrovec GW, Landwehr DM, Edwards VL. Incidence of renal artery stenosis in hypertensive patients undergoing coronary angiography. J Intervent Cardiol. 1989;2:69–76
  8. Conlon PJ, Little MA, Pieper K, Mark DB. Severity of renal vascular disease predicts mortality in patients undergoing coronary angiography. Kidney Int. 2001;60:1490–1497[CrossRef][ISI][Medline]
  9. Campeau L. Grading of angina pectoris (letter). Circulation. 1970;54:522–523
  10. Goldman L, Hashimoto B, Cook EF, Loscalzo A. Comparative reproducibility and validity of systems for assessing cardiovascular functional class: advantages of a new specific activity scale. Circulation. 1981;64:1227–1234[Abstract/Free Full Text]
  11. Hekali P. Coronary angiography and clinical symptomatology. Acta Radiol Suppl. 1976;354:1–80[Medline]
  12. Cockroft DW, Gault MH. Prediction of creatinine clearance from serum creatinine. Nephron. 1976;16:31–41[ISI][Medline]
  13. Hilden J, Glasziou P. Regret graphs, diagnostic uncertainty and Youden's Index. Stat Med. 1996;30:969–986
  14. Altman DG, Machin D, Bryant TN. Statistics with confidence. London: BMJ Books; 2000.
  15. Conlon PJ, O'Riordan E, Kalra PA. New insights into the epidemiologic and clinical manifestations of atherosclerotic renovascular disease. Am J Kid Dis. 2000;35:573–587[ISI][Medline]
  16. Preston RA, Epstein M. Ischemic renal disease: an emerging cause of chronic renal failure and end-stage renal disease. J Hypertens. 1997;15:1365–1377[CrossRef][ISI][Medline]
  17. McCullough PA, Wolyn R, Rocher LL. Acute renal failure after coronary intervention: incidence, risk factors, and relationship to mortality. Am J Med. 1997;103:368–375[CrossRef][ISI][Medline]
  18. Murphy SW, Barrett BJ, Parfrey PS. Contrast nephropathy. J Am Soc Nephrol. 2000;11:177–182[Free Full Text]
  19. Krumme B, Mann JFE. Atherosclerotic renal artery stenosis in 2001—are we less confused than before? Nephrol Dial Transplant. 2001;16:2124–2127[Free Full Text]
  20. Radermacher J, Chavan A, Bleck J. Use of Doppler ultrasonography to predict the outcome of therapy for renal-artery stenosis. N Engl J Med. 2001;344:410–417[Abstract/Free Full Text]
  21. Plouin PF, Rossignol P, Bobrie G. Atherosclerotic renal artery stenosis: to treat conservatively, to dilate, to stent, or to operate? J Am Soc Nephrol. 2001;12:2190–2196[Free Full Text]
  22. Fried LA, Orchard TJ, Kasiske BL. Effect of lipid reduction on the progression of renal disease: a meta-analysis. Kidney Int. 2001;59:260–269[CrossRef][ISI][Medline]
  23. Safian RD, Textor ST. Renal artery stenosis. N Engl J Med. 2001;344:431–442[Free Full Text]
  24. Beutler JJ, van Ampting JMA, van de Ven PJG. Long-term effects of arterial stenting on kidney function for patients with ostial atherosclerotic renal artery stenosis and renal insufficiency. J Am Soc Nephrol. 2001;12:1475–1481[Abstract/Free Full Text]
  25. Kidney D, Deutsch LS. The indications and results of percutaneous transluminal angioplasty and stenting in renal artery stenosis. Semin Vasc Surg. 1996;9:188–197[Medline]

Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us    What's this?


This article has been cited by other articles:


Home page
 Nephrol Dial TransplantHome page
T. Przewlocki, A. Kablak-Ziembicka, W. Tracz, G. Kopec, P. Rubis, M. Pasowicz, P. Musialek, M. Kostkiewicz, A. Kozanecki, T. Stompor, et al.
Prevalence and prediction of renal artery stenosis in patients with coronary and supraaortic artery atherosclerotic disease
Nephrol. Dial. Transplant., February 1, 2008; 23(2): 580 - 585.
[Abstract] [Full Text] [PDF]

Home page
 J Am Coll CardiolHome page
B. De Bruyne, G. Manoharan, N. H.J. Pijls, K. Verhamme, J. Madaric, J. Bartunek, M. Vanderheyden, and G. R. Heyndrickx
Assessment of Renal Artery Stenosis Severity by Pressure Gradient Measurements
J. Am. Coll. Cardiol., November 7, 2006; 48(9): 1851 - 1855.
[Abstract] [Full Text] [PDF]

Home page
 CirculationHome page
C. J. White, M. R. Jaff, Z. J. Haskal, D. J. Jones, J. W. Olin, K. J. Rocha-Singh, K. A. Rosenfield, J. H. Rundback, and S. L. Linas
Indications for Renal Arteriography at the Time of Coronary Arteriography: A Science Advisory From the American Heart Association Committee on Diagnostic and Interventional Cardiac Catheterization, Council on Clinical Cardiology, and the Councils on Cardiovascular Radiology and Intervention and on Kidney in Cardiovascular Disease
Circulation, October 24, 2006; 114(17): 1892 - 1895.
[Abstract] [Full Text] [PDF]

Home page
 CirculationHome page
C. J. White
Catheter-Based Therapy for Atherosclerotic Renal Artery Stenosis
Circulation, March 21, 2006; 113(11): 1464 - 1473.
[Full Text] [PDF]

Home page
 Eur Heart JHome page
R. de Silva, N. P. Nikitin, S. Bhandari, A. Nicholson, A. L. Clark, and J. G.F. Cleland
Atherosclerotic renovascular disease in chronic heart failure: should we intervene?
Eur. Heart J., August 2, 2005; 26(16): 1596 - 1605.
[Abstract] [Full Text] [PDF]

Home page
 J Am Coll CardiolHome page
C. E. Buller, J. G. Nogareda, K. Ramanathan, D. R. Ricci, O. Djurdjev, K. J. Tinckam, I. M. Penn, R. S. Fox, L. A. Stevens, J. A. Duncan, et al.
The profile of cardiac patients with renal artery stenosis
J. Am. Coll. Cardiol., May 5, 2004; 43(9): 1606 - 1613.
[Abstract] [Full Text] [PDF]

Home page
 Am. J. Roentgenol.Home page
R. C. Carlos, D. A. Axelrod, J. H. Ellis, P. H. Abrahamse, and A. M. Fendrick
Incorporating Patient-Centered Outcomes in the Analysis of Cost-Effectiveness: Imaging Strategies for Renovascular Hypertension
Am. J. Roentgenol., December 1, 2003; 181(6): 1653 - 1661.
[Abstract] [Full Text] [PDF]

This Article
Right arrow Abstract Freely available
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in ISI Web of Science
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My Personal Archive
Right arrow Download to citation manager
Right arrow Search for citing articles in:
ISI Web of Science (34)
Right arrowRequest Permissions
Google Scholar
Right arrow Articles by Weber-Mzell, D.
Right arrow Articles by Skrabal, F.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Weber-Mzell, D.
Right arrow Articles by Skrabal, F.
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us  
What's this?