Proteinuria in atherosclerotic renovascular disease

Proteinuria is well described in atherosclerotic renovascular disease (ARVD ), but the prevalence is unknown, and the pathogenesis may vary between pat ients. Substantial proteinuria (>2 g/day) however, would be regarded by man y as atypical of ARVD. We studied 94 patients (52 male) with ARVD, median a ge 67 years (range 49-87). Digital subtraction angiography was performed on all patients. Protein was assayed in 24-h urine samples and GFR derived us ing the Cockroft-Gault formula. Forty-nine patients (52%) had proteinuria < 0.5 g/24 h. Proteinuria increased with worsening renal function. Biopsies f rom seven non-diabetic patients with substantial proteinuria showed: minima l changes (1); glomerular sclerosis with marked ischaemic changes (3); foca l glomerulosclerosis (2); and athero-emboli (1). Proteinuria, rather than b eing indicative of other pathology, is often a marker of severity of parenc hymal disorder in atherosclerotic nephropathy, which itself is the major de terminant of renal dysfunction in patients with ARVD.