Morphology of coronary atherosclerotic lesions in patients with end-stage renal failure

Background. An excessive rate of cardiac death is a well-known feature of r enal failure. Coronary heart disease is frequent and the possibility has be en raised that the natural history of the coronary plaque is different in u raemic patients. We assessed the morphology of coronary arteries in patient s with end-stage renal failure and compared them with coronary arteries of matched non-uraemic control patients. Methods. Fifty-four cases were identified at autopsy who met the inclusion criteria: cases, end-stage renal disease (n=27); controls, non-renal patien ts with coronary artery disease (n=27). At autopsy all three coronary arter ies were prepared at corresponding sites for investigations: (i) qualitativ e analysis (after Stary), (ii) quantitative measurements of intima and medi a thickness (by planimetry), (iii) immunohistochemical analysis of the coro nary plaques and (iv) X-ray diffraction of selected calcified plaques. Results. Qualitative analysis of the coronary arteries showed significantly more calcified plaques of coronary arteries in patients with end-stage ren al failure. Plaques of non-uraemic patients were mostly fibroatheromatous. Media thickness of coronary arteries was significantly higher in uraemic pa tients (187+/-53 mu m vs 135+/-29 mu m in controls) and intima thickness te nded to be higher (158+/-38 mu m vs 142+/-31 mu m) but this difference was not statistically significant. Plaque area (4.09+/-1.50 mm(2) vs 4.39+/-0.8 8 mm(2)) was comparable in both groups. Lumen area, however, was significan tly lower in end-stage renal patients. Immunohistochemical analysis of the cellular infiltrate in coronary arteries showed no major differences in the se advanced plaques of uraemic and non-uraemic subjects. Conclusion. Coronary plaques in patients with endstage renal failure are ch aracterized by increased media thickness and marked calcification. In contr ast to the previous opinion the most marked difference compared to non-urae mic controls does not concern the size, but the composition of the plaque. Deposition of calcium within the plaques may contribute to the high complic ation rate in uraemic patients.