Evaluating patients with renal failure for renal artery stenosis with gadolinium-enhanced magnetic resonance angiography

The incidence and prevalence of end-stage renal disease (ESRD) continues to increase, especially in the elderly population. The role of renovascular d isease in contributing to ESRD is still not well defined. The objective of this study was to determine the utility of gadolinium (Gd)-enhanced magneti c resonance angiography (MRA) in evaluating elderly patients with renal ins ufficiency for renal artery stenosis (RAS), A 7-month prospective study con ducted in a tertiary referral center evaluated 40 consecutive patients with progressive renal insufficiency (18 men and 22 women; mean age, 70 +/- 5.6 [standard deviation] years) and high clinical suspicion for renovascular d isease with Gd-enhanced MRA, Digital substraction angiography (DSA) was obt ained in only those patients with significant RAS detected by MRA. Twelve p atients had significant RAS. Six of these patients had percutaneous translu minal renal angioplasty (PTRA), five patients had renal artery bypass surge ry, and one patient had a stent placed after PTRA, Seventy-eight renal arte ries were satisfactorily evaluated by MRA. Twenty-two renal arteries were e valuated by both MRA and DSA. Of the 12 significant stenoses detected by th e MRA, 11 were confirmed by DSA and 1 was confirmed at the time of surgical revascularization, It is concluded that Gd-enhanced MRA is a useful test f or the evaluation of RAS in patients with compromised renal function. (C) 1 999 by the National Kidney Foundation, Inc.