Nephrotic-range proteinuria in patients with renovascular disease

PURPOSE: Proteinuria is usually considered a manifestation of glomerular di sease. We sought to describe the characteristics of patients with nephrotic -range proteinuria resulting from renovascular disease and to compare them with those of patients who had glomerulonephritis. SUBJECTS AND METHODS: We identified 14 patients with nephrotic-range protei nuria and renovascular disease and compared them with 14 patients who bad n ephrotic-range proteinuria and biopsy-proven glomerulonephritis, matched fo r sex, age, and glomerular filtration rate. RESULTS: Patients with renovascular disease were more likely to have known atherosclerotic vascular disease [13 of 14 (93%) vs 3 of 14 (21%),P<0.0001] and were usually smokers [12 of 14 (85%) vs 3 of 14 (21%), P <0.0001]. The y also had a greater mean (+/- SD) difference between the lengths of their kidneys (29 +/- 10 vs 5 +/- 5 mm, P <0.001); greater systolic blood pressur e (203 +/- 22 vs 174 +/- 25 mm Hg, P <0.005), plasma renin activity (17 +/- 19 vs 2 +/- 2 ng/mL/h, P = 0.005), and plasma aldosterone concentration (4 0 +/- 23 vs 11 +/- 10 ng/dL, P = 0.0001); and lower serum potassium levels (3.3 +/- 0.5 vs 3.8 +/-0.5, P <0.05). Effective renal plasma flow was lower (139 +/- 68 vs 307 +/- 185 mL/min/1.73 m(3)) and filtration fraction was m arkedly greater (0.28 +/- 0.04 vs 0.15 +/- 0.07,P = 0.0001) in the patients with renovascular disease. After the oral administration of captopril, blo od pressure, effective renal plasma Row, and glomerular filtration rate dec reased only among patients with renovascular disease. Of the 14 patients wi th renovascular disease, 13 had evidence of renal artery thrombosis seen at angiography; 2 patients required dialysis, and 3 others died during follow -up. CONCLUSION: Our findings suggest that the patients with nephrotic-range pro teinuria resulting from renovascular disease have distinct characteristics and a poor prognosis. (C) 2000 by Excerpta Medica, Inc.