Jo. Connolly et al., PRESENTATION, CLINICAL-FEATURES AND OUTCOME IN DIFFERENT PATTERNS OF ATHEROSCLEROTIC RENOVASCULAR DISEASE, Quarterly Journal of Medicine, 87(7), 1994, pp. 413-421
Atherosclerotic renovascular disease (ARD) is an increasingly importan
t cause of renal failure. However, important features of the clinical
presentation are not fully described, and the outcome after interventi
on by angioplasty remains controversial. Ninety-four patients with ARD
diagnosed at angiography were reviewed. Twenty-four patients were dia
betic. Thirty-nine patients had unilateral renal artery stenosis or oc
clusion (group A), 28 had bilateral stenosis (group B), and 27 had uni
lateral occlusion plus contralateral occlusion or stenosis (group C).
Two years after presentation, actuarial patient survival was 96%, 74.3
% and 47.1% in groups A, B and C, respectively (p<0.001 for all differ
ences); actuarial renal survival in surviving patients was 97.3%, 82.4
% and 44.7%, respectively (p<0.001 for all differences). Percutaneous
transluminal balloon angioplasty (PCTA) was performed in 74 patients.
penal function improved in only a minority of cases, but was stable in
73% of nondiabetic patients 12 months after PCTA. Angioplasty was les
s effective in diabetic subjects, with only 53.3% having stable renal
function at 12 months follow-up. Renal and patient survival were stron
gly related to the initial angiographic findings. In nondiabetic subje
cts, PCTA resulted in stabilization of renal function for at least one
year in nearly three-quarters of cases, which suggests a benefit from
intervention in this disease whose natural history is otherwise of pr
ogression.