Renal artery stenosis by three-dimensional magnetic resonance angiography in type 2 diabetics with uncontrolled hypertension and chronic renal insufficiency: Prevalence and effect on renal function

• Published in: American journal of kidney diseases Vol. 41; no. 2; pp. 351 - 359
• Main Authors: Myers, Donna I., Poole, Lynn J., Imam, Khursheed, Scheel, Paul J., Eustace, Joseph A.
• Format: Journal Article
• Language: English
• Published: Orlando, FL Elsevier Inc 01-02-2003; Elsevier
• Subjects: Adult; Aged; Aged, 80 and over; Baltimore - epidemiology; Biological and medical sciences; Diabetes Mellitus, Type 2 - complications; Diabetes Mellitus, Type 2 - physiopathology; Disease Progression; Endocrine pancreas. Apud cells (diseases); Endocrinopathies; Female; Follow-Up Studies; Humans; Hypertension - epidemiology; Hypertension - etiology; Hypertension - physiopathology; Imaging, Three-Dimensional - methods; Kidney Failure, Chronic - epidemiology; Kidney Failure, Chronic - etiology; Kidney Failure, Chronic - therapy; Magnetic Resonance Angiography - methods; Male; Medical sciences; Middle Aged; Multivariate Analysis; Prevalence; Renal Artery Obstruction - diagnosis; Renal Artery Obstruction - epidemiology; Renal Artery Obstruction - pathology; Renal Artery Obstruction - therapy; Renal Dialysis - methods; Renal Dialysis - statistics & numerical data; Risk Factors; Stents; Tumors. Hypoglycemia; Baltimore; Endocrinopathy; Kidney disease; Human; Hypertension; three-dimensional magnetic resonance angiography (3D-MRA); Urinary system disease; Prevalence; Renal artery; secondary hypertension; Stenosis; Cardiovascular disease; Nuclear magnetic resonance imaging; Non insulin dependent diabetes; Renal artery stenosis (RAS); Arterial disease; Vascular disease; Chronic; Three dimensional representation; Renal failure; Medical imagery; atherosclerotic renovascular disease; NMR angiography; diabetic nephropathy; Renal artery disease
• ISSN: 0272-6386; 1523-6838
• DOI: 10.1053/ajkd.2003.50043

Background: The variable course of renal disease in type 2 diabetes mellitus in part may reflect associated atherosclerotic nephropathy. Methods: To determine the influence of subcritical (<65%) renal artery stenosis (RAS) on the progression of chronic kidney disease, 45 patients with type 2 diabetes with uncontrolled hypertension and serum creatinine levels of 1.8 mg/dL or greater (≥159.1 μmol/L) were screened by three-dimensional magnetic resonance angiography (MRA). Mean monthly decrease in reciprocal serum creatinine × 100 and time to initiation of dialysis therapy, adjusting for baseline serum creatinine level, were compared in those with and without RAS. Follow-up was censored at the time of death or angioplasty. Results: At baseline, RAS-negative (RAS−; n = 27) and RAS-positive (RAS+; n = 18) groups were similar in duration of diabetes and hypertension, hyperlipidemia, blood pressure, diabetic management, and renal function. RAS+ subjects were older (P = 0.04) and more likely to have claudication (P = 0.006), smoke (P = 0.02), and have heart disease (P = 0.06). During a median follow-up of 9.4 months, 3 patients underwent stent placement, 2 patients died, and 12 patients progressed to dialysis therapy. The RAS+ group had a more rapid monthly decline in reciprocal serum creatinine × 100 (mean, 1.63 ± 0.9 versus 0.69 ± 1.0 [SD]; P = 0.04). The relative risk for progression to end-stage renal disease was 2.4 in the RAS+ versus RAS− group. Multivariate analysis showed that this effect was not independent of several established atherosclerotic risk factors. Conclusion: MRA-detected RAS is common (40%) in patients with type 2 diabetes with uncontrolled hypertension and renal insufficiency. Subcritical (<65%) RAS is a significant risk factor for progressive renal failure. Am J Kidney Dis 41:351-359.