RISK OF ATROPHY IN KIDNEYS WITH ATHEROSCLEROTIC RENAL-ARTERY STENOSIS

The goal of this study was to determine the incidence of and risk fact ors for renal atrophy among kidneys with atherosclerotic renal artery stenosis (ARAS). Participants with at least one ARAS were followed pro spectively with duplex scans performed every six months. Renal atrophy was defined as a reduction in renal length of greater than 1 cm. A to tal of 204 kidneys in 122 subjects were followed for a mean of 33 mont hs. The two-year cumulative incidence (CI) of renal atrophy was 5.5%, 11.7%, and 20.8% in kidneys with a baseline renal artery disease class ification of normal, < 60% stenosis, and greater than or equal to 60% stenosis, respectively (P = 0.009, log rank test). Other baseline fact ors associated with a high risk of renal atrophy included a systolic b lood pressure > 180 mm Hg (2-year CI = 35%, P = 0.01), a renal artery peak systolic velocity > 400 cm/second (2-year CI = 32%, P = 0.02), an d a renal cortical end diastolic velocity less than or equal to 5 cm/s econd (2-year CI = 29%, P = 0.046). The number of kidneys demonstratin g atrophy per participant was correlated with elevations in the serum creatinine concentration (P = 0.03). In patients with ARAS, there is a significant risk of renal atrophy among kidneys exposed to elevated s ystolic blood pressure and among those with high-grade ARAS and low re nal cortical blood flow velocity as assessed by renal duplex scanning. The occurrence of renal atrophy is well-correlated with changes in th e serum creatinine concentration.