[Selective kidney angiography within the scope of heart catheterization: pathological findings and therapeutic...

The importance of renal artery stenosis as a cause of refractory hypertension, recurrent pulmonary edema and renal failure is being increasingly recognized. The prevalence and clinical consequences of renovascular and macroscopic renal parenchymal pathology in patients undergoing coronary angiography is assessed prospectively.

Selective renal artery angiography was performed in 190 consecutive patients following coronary angiography and prior to PTCA if indicated. Diagnostic yield, therapeutic consequences, complications and fluoroscopy time were noted.

Mean age as 63 (+/- 11) years, 74% of patients were males. Mean fluoroscopy time (including PTCA or PTA) was 8 (+/- 11) minutes. The pathological renal and renovascular findings included critical atherosclerotic renal artery stenosis in four patients (2%), non critical (angiographically < 60%) stenosis in 22 patients (12%), double arterial supply on one side in 26 patients (14%), on both sides in seven patients (4%), fibromuscular dysplasia in two patients (1%) and large renal cyst, renal artery aneurysm and aberrant blood supply of an ectopic pelvic kidney in one patient (0.5%). The four patients with critical renal artery stenosis underwent primarily successful PTA and stenting.

Selective renal angiography in the wake of coronary angiography is safe and inexpensive. Furthermore, it can be performed easily in the majority of cases. The diagnostic yield of renal angiography ist not negligible; 2% of patients had critical renal artery stenosis with an unequivocal indication for an interventional procedure. Progression of (as yet) nonsignificant renal artery stenosis is reported in a large number of cases, meaning that early diagnosis may have later therapeutic consequences. Ad hoc PTA and stenting is the treatment of choice for significant renal artery stenosis.