Original Report: Patient-Oriented, Translational Research

Incidental Atherosclerotic Renal Artery Stenosis in Patients Undergoing Elective Coronary Angiography: Are These Lesions Significant?
M.E. Schachter, N. Zalunardo, C. Rose, P. Taylor, C. Buller, M. Kiaii, J. Duncan, A. Levin

UBC Division of Nephrology and UBC Division of Cardiology, St. Paul's Hospital and Vancouver General Hospitals, Vancouver, B.C., Canada

Address of Corresponding Author

Am J Nephrol 2009;29:434-439 (DOI: 10.1159/000174856)

  Key Words

• Hypertension
• Nuclear renogram
• Renal artery stenosis
• Renal angiography

  Abstract

Background: Cardiologists often identify atherosclerotic renal artery stenosis (ARAS) during cardiac angiography. The importance of such 'incidental' ARAS (iARAS) is not known. The present study sought to describe renal perfusion using non-captopril (baseline) nuclear renograms in patients with iARAS, and to determine characteristics associated with a positive captopril renogram. Methods: Patients presenting for non-emergent coronary angiography between June 2001 and February 2006 were angiographically screened for iARAS. Those with >50% stenosis of one or both renal arteries were referred to nephrology and underwent nuclear renography. Results: 131 patients had renograms. The mean age was 73.2 ±8.1 and median eGFR was 51.2 (40.0, 66.6) ml/min/1.73 m². 51% had evidence of reduced perfusion to one kidney, of which 13% were discordant with the angiographic lesion. 9% had positive captopril renograms. Captopril renogram positivity was associated with severe unilateral stenosis (p = 0.02). Conclusions: In cardiac patients diagnosed with iARAS, the presence of known anatomic lesions did not correlate with captopril renogram positivity. Uncertainty remains as to whether nuclear renography is a poor functional test in this population, or the lesions are not functionally significant. These results lead us to question both the significance of such lesions, and the utility of conducting renograms in this population.

Copyright © 2008 S. Karger AG, Basel

  Author Contacts

M. Schachter
St. Paul's Hospital, Division of Nephrology
1081 Burrard Street, Providence Wing RM 6010A
Vancouver, B.C. V6Z 1Y8 (Canada)
Tel. +1 604 802 2608, Fax +1 604 806 8120, E-Mail mschac1@hotmail.com

  Article Information

Received: July 16, 2008
Accepted: September 14, 2008
Published online: November 14, 2008
Number of Print Pages : 6
Number of Figures : 4, Number of Tables : 2, Number of References : 18