The natural history of incidental renal artery stenosis in patients with aortoiliac vascular disease

PURPOSE: To examine the association between incidentally discovered renal a rtery stenosis and deterioration of renal function as determined by the cha nge in serum creatinine concentration over time. SUBJECTS AND METHODS: We performed a retrospective review of consecutive pa tients who underwent aortography for aortoiliac vascular disease. Angiogram s were reviewed for renal artery stenosis, defined as a narrowing of at lea st 20% compared with adjacent normal renal artery. For patients with at lea st 180 days of subsequent follow-up, the change in serum creatinine concent ration per year was compared in patients who had or did not have renal arte ry stenosis. RESULTS: Of the 201 patients, 96 (48%) had some degree of renal artery sten osis in one or both renal arteries, including 53 (26%) who had at least one stenosis greater than or equal to 50% and 40 (20%) who had bilateral steno ses. The only clinical predictor of renal artery stenosis was a history of coronary artery disease (odds ratio = 2.0, 95% confidence interval: 1.2 to 3.8, P = 0.001). Among the 174 patients with greater than or equal to 180 d ays of follow-up, there was no statistically significant difference (P = 0. 88) in the mean change in serum creatinine concentration per year in the 78 patients with renal artery stenosis (0.06 +/- 0.33 mg/dL per year) as comp ared with the 96 patients without renal artery stenosis (0.06 +/- 0.22 mg/d L per year). Grouping the patients by the maximal percentage of stenosis di d not reveal any difference in the mean changes in serum creatinine concent ration per year. CONCLUSIONS: Although renal artery stenosis is a common incidental finding in patients with atherosclerotic vascular disease, it is an uncommon cause of progressive renal disease. (C) 2000 by Excerpta Medica, Inc.