ALBUMINURIA PREDICTS RENAL FUNCTIONAL OUTCOME AFTER INTERVENTION IN ATHEROMATOUS RENOVASCULAR DISEASE

Background: Atheromatous renovascular disease is increasingly recogniz ed as a cause of renal failure; however, the benefit of intervention o n renal function outcome cannot be clearly anticipated. Objective: To identify reliable predictor(s) of renal functional outcome after revas cularization in patients with atheromatous renovascular disease. Desig n: The effect of percutaneous transluminal renal angioplasty (n = 5) o r surgery (n = 18) on glomerular filtration rate ([Tc-99m]-diethylene triaminopenta-acetic acid clearance) and renal haemodynamics was prosp ectively assessed in 23 patients with atheromatous renovascular diseas e (unilateral occlusion in five, unilateral stenosis in four, stenosis of a single kidney in five, unilateral occlusion associated with cont ralateral stenosis in six, bilateral stenosis in three). Renal functio n was altered in 18 patients. Results: At early follow-up study (5 +/- 1 months) after intervention, glomerular filtration rate improved (i. e. increased by more than 15%) in six patients, deteriorated in five a nd remained unchanged in 12 patients. The change in glomerular filtrat ion rate associated with intervention was inversely correlated with th e pre-intervention level of urinary albumin excretion and positively w ith the change in effective renal plasma flow after intervention. Step wise regression analysis showed that pre-intervention urinary albumin excretion was the only predictor of the glomerular filtration rate res ponse to intervention. At late follow-up study (32 +/- 6 months, n = 1 3), glomerular filtration rate was stable compared with early follow-u p determination in non-proteinuric patients whereas it had deteriorate d further in proteinuric patients. Conclusion: In patients with athero matous renovascular disease, albuminuria may be considered as a marker of pre-existing intra-renal vascular and glomerular damage and a reli able predictor of renal functional outcome after intervention.