The impact of atherosclerotic renovascular disease on diabetic renal failure

Area of Science:

• Nephrology
• Cardiology
• Diabetology

Background:

• Atherosclerotic renovascular disease (ARVD) is a prevalent condition, particularly in aging populations and individuals with diabetes.
• The use of ACE inhibitors and ARBs in diabetic patients with potential renal artery stenosis raises concerns about iatrogenic harm.
• Understanding the natural history of ARVD is crucial for guiding treatment strategies.

Purpose of the Study:

• To review the natural history of atherosclerotic renovascular disease in both diabetic and non-diabetic individuals.
• To evaluate the risks and benefits of intervention versus conservative management for ARVD.
• To inform clinical decision-making regarding renal revascularization in patients with suspected ARVD.

Main Methods:

• Systematic review of existing literature on the natural history and management of ARVD.
• Analysis of prevalence, progression, and outcomes of ARVD in diabetic and non-diabetic cohorts.
• Evaluation of current therapeutic approaches, including watchful waiting, angiography, and angioplasty with stenting.

Main Results:

• ARVD is common but infrequently leads to end-stage renal disease.
• Intervention based solely on radiological findings may result in unnecessary procedures.
• A 'watchful waiting' approach appears suitable for most diabetic patients with suspected ARVD.

Conclusions:

• Renal revascularization for ARVD should be reserved for patients with a significant decline in renal function unexplained by other causes.
• Angiography and angioplasty with stenting are indicated in select cases of abrupt renal function deterioration.
• Further randomized clinical trials are needed to identify specific patient subgroups who benefit from renal revascularization.