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Incidence of donor renal fibromuscular dysplasia: does it justify routine angiography?
Kenneth A Andreoni1, Susan M Weeks, David A Gerber
1Division of Transplantation, Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599, USA. Kenneth_Andreoni@med.unc.edu
Insights
Digital subtraction angiography (DSA) is crucial for detecting fibromuscular dysplasia (FMD) in live kidney donors. Non-invasive imaging like CT or MR angiography may miss mild FMD, potentially impacting donor safety and recipient outcomes.
Area of Science:
- Nephrology
- Vascular Surgery
- Radiology
Background:
- Live renal donor evaluation involves controversial imaging modalities.
- Helical CT angiography (CTA) and MR angiography (MRA) may miss mild or distal fibromuscular dysplasia (FMD).
- Digital subtraction angiography (DSA) remains a gold standard for detecting subtle arterial changes.
Purpose of the Study:
- To evaluate the incidence of fibromuscular dysplasia (FMD) in potential live renal donors.
- To compare the efficacy of DSA with non-invasive imaging (CTA/MRA) in detecting FMD.
- To assess the long-term implications of undetected FMD in living kidney donors.
Main Methods:
- Retrospective chart review of 159 potential live renal donors from July 1995 to June 2001.
- All donors underwent digital subtraction angiography (DSA) as part of their evaluation.
- Analysis of renal artery anatomy and identification of fibromuscular dysplasia (FMD).
Main Results:
- Seven cases of fibromuscular dysplasia (FMD) were detected, an incidence of 4.4%.
- Three FMD patients had bilateral disease; two required antihypertensive medications within 4 years.
- Undetected FMD could lead to complications in the remaining native kidney or transplanted organ.
Conclusions:
- CTA and MRA may overlook mild, DSA-detectable fibromuscular dysplasia (FMD).
- Undiagnosed FMD in potential donors can have significant long-term health consequences.
- DSA remains essential for comprehensive renal artery assessment in live kidney donor selection.
Background:
The use of digital subtraction angiography (DSA) versus helical CT angiography (CTA) or MR angiography (MRA) for live renal donor evaluation is still controversial. Although CTA and MRA can detect some proximal moderate to severe arterial changes caused by fibromuscular dysplasia (FMD), mild and distal moderate FMD are not detected well without angiography.
Methods:
This is a retrospective chart review of all potential, normotensive live renal donors at our center from July 1995 to June 2001. One hundred fifty-nine patients completed the donor evaluation process and underwent DSA.
Results:
Seven cases of FMD, an incidence of 4.4%, were discovered. These patients were eliminated from donation. The distribution of renal vessels for our 159 patients was single arteries bilaterally, 64.8%; single left with multiple right, 16.4%; double left with single right, 9.4%; and multiple bilateral arteries, 9.4%. Three of the seven FMD patients had bilateral disease. Two of the seven (28.6%) FMD patients have subsequently required antihypertensive medications, with one requiring angioplasty of a progressive FMD stenotic lesion.
Conclusions:
We are concerned that CTA or MRA may overlook mild cases of DSA-detectable FMD. All seven FMD patients had single left renal arteries and would have undergone left donor nephrectomy. This would have resulted in their remaining right native kidneys having mild to moderate FMD in six of seven patients and in four donor kidneys having mild to moderate FMD. The need for antihypertensive medications in two of these seven potential donors within 4 years of their evaluation supports previous literature reports.