NTRODUCTION AND AIMS Ischemic renal disease (IRD) is caused by hemodynamically significant mono or bilateral renal artery stenosis. IRD is responsible for reduction of glomerular filtration rate (GFR) and/or loss of renal parenchyma. Clinical features can be renovascular hypertension and ischemic nephropathy. The exact prevalence of IRD is not well known since it is often asymptomatic. Therefore few patients are screened for IRD unless they become symptomatic. Ischemic nephropathy prevalence are based on autopsies and angiographic studies in patients with renovascular hypertension or atherosclerotic disease. This study aimed at assessing the prevalence of IRD, defining its clinic characteristics, evaluating useful imaging procedures in a cohort of patients with chronic kidney disease not in dialysis (CKD) and atherosclerotic lesions. METHODS 1607 CKD patients were retrospectively evaluated during the period 2008-2013 referred to the “Federico II” Department of Nephrology, Naples. Inclusion criteria were: CKD ( I - V KDOQI stages), presence of atherosclerotic lesions anywhere in arterial tree. Kidney transplant recipients and patients with chronic kidney disease requiring dialysis were excluded. Clinical characteristics ( age, sex, blood pressure, body weight, BMI, height), medical history ( previous cardiovascular events, history of familiar cardiovascular events,diabetes mellitus, hypertension ),data of imaging procedures ( angio-TC, angio- RM, color doppler ultrasound (US), renal scintigraphy, angiography, coronarography ) were collected. RESULTS 1 284 patients fulfilled inclusion criteria. Clinical characteristics are reported in Fig 1. Causes of CKD in the study cohort were: hypertension (16,9%), diabetes mellitus (13%), glomerulonephritis (10.9%), interstitial nephritis (3.2%), kidney stones (2.5%), polycystic kidney disease (1.8%),unknown (40%) . IRD prevalence was 11,3 %. The main imaging procedure used to detect renal artery stenosis was color-doppler US (71,9%) in IRD. Other imaging procedures were: angio TC (32%), renal scintigraphy (31%), renal angiography (15%), angio RM (12%). Compared to others, patients with IRD had higher prevalence of history of cardiovascular events in family (46.9% Vs 33.7%) (NS), dyslipidemia (84.4% vs 69%) (NS) and previous cardiovascular events (53.1% vs 32.1%) (NS) . CONCLUSIONS The present study shows that the IRD is frequently misdiagnosed. More careful evaluation should be performed among patients with not well defined cause of CKD and concomitant presence of atherosclerotic lesions on arterial tree. Color-doppler US is the most useful imaging procedure to identify IRD.
Occurrence of ischemic nephropathy in patients with atherosclerotic lesions. Retrospective Study / Battaglia, Yuri; Prete, Marco Antonio Del; Gregorio, Maria Grazia De; Errichiello, Carmela; Gisonni, Pietro; Russo, Luigi; Scognamiglio, Bernadette; Storari, Alda; Russo, Domenico. - In: NEPHROLOGY DIALYSIS TRANSPLANTATION. - ISSN 1460-2385. - (2014). (Intervento presentato al convegno 51st Congress of the European Renal Association and European Dialysis and Transplant Association 2014).
Occurrence of ischemic nephropathy in patients with atherosclerotic lesions. Retrospective Study
BATTAGLIA, YURI;ERRICHIELLO, CARMELA;RUSSO, LUIGI;SCOGNAMIGLIO, BERNADETTE;RUSSO, DOMENICO
2014
Abstract
NTRODUCTION AND AIMS Ischemic renal disease (IRD) is caused by hemodynamically significant mono or bilateral renal artery stenosis. IRD is responsible for reduction of glomerular filtration rate (GFR) and/or loss of renal parenchyma. Clinical features can be renovascular hypertension and ischemic nephropathy. The exact prevalence of IRD is not well known since it is often asymptomatic. Therefore few patients are screened for IRD unless they become symptomatic. Ischemic nephropathy prevalence are based on autopsies and angiographic studies in patients with renovascular hypertension or atherosclerotic disease. This study aimed at assessing the prevalence of IRD, defining its clinic characteristics, evaluating useful imaging procedures in a cohort of patients with chronic kidney disease not in dialysis (CKD) and atherosclerotic lesions. METHODS 1607 CKD patients were retrospectively evaluated during the period 2008-2013 referred to the “Federico II” Department of Nephrology, Naples. Inclusion criteria were: CKD ( I - V KDOQI stages), presence of atherosclerotic lesions anywhere in arterial tree. Kidney transplant recipients and patients with chronic kidney disease requiring dialysis were excluded. Clinical characteristics ( age, sex, blood pressure, body weight, BMI, height), medical history ( previous cardiovascular events, history of familiar cardiovascular events,diabetes mellitus, hypertension ),data of imaging procedures ( angio-TC, angio- RM, color doppler ultrasound (US), renal scintigraphy, angiography, coronarography ) were collected. RESULTS 1 284 patients fulfilled inclusion criteria. Clinical characteristics are reported in Fig 1. Causes of CKD in the study cohort were: hypertension (16,9%), diabetes mellitus (13%), glomerulonephritis (10.9%), interstitial nephritis (3.2%), kidney stones (2.5%), polycystic kidney disease (1.8%),unknown (40%) . IRD prevalence was 11,3 %. The main imaging procedure used to detect renal artery stenosis was color-doppler US (71,9%) in IRD. Other imaging procedures were: angio TC (32%), renal scintigraphy (31%), renal angiography (15%), angio RM (12%). Compared to others, patients with IRD had higher prevalence of history of cardiovascular events in family (46.9% Vs 33.7%) (NS), dyslipidemia (84.4% vs 69%) (NS) and previous cardiovascular events (53.1% vs 32.1%) (NS) . CONCLUSIONS The present study shows that the IRD is frequently misdiagnosed. More careful evaluation should be performed among patients with not well defined cause of CKD and concomitant presence of atherosclerotic lesions on arterial tree. Color-doppler US is the most useful imaging procedure to identify IRD.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
