Renal atrophy outcome after revascularization in fibromuscular dysplasia disease

To assess clinical, biological, and kidney parameters before and 6 months after revascularization of renal artery stenosis due to fibromuscular dysplasia (FMD).

Twenty hypertensive patients (18 women; mean age 48.7 +/- 15.4 years) with unilateral de novo FMD stenosis were studied before and 6 months after revascularization (balloon angioplasty 19; bypass surgery 1). Blood pressure and creatinine clearance were measured, and renal length, cortical thickness, cortical area (CA), and medullary length (ML) were evaluated by spiral computed tomographic angiography (CTA) in 20 poststenotic and 20 contralateral kidneys.

Six months after revascularization, the systolic and diastolic blood pressures decreased by 19 mmHg and 10 mmHg, respectively (p=0.02), the number of antihypertensive drugs decreased by 1 (p=0.01), but the increase in creatinine clearance was not significant. At baseline, the poststenotic kidneys were significantly more atrophied than the contralateral normal kidney (ML in normal kidney 89 +/- 9 mm versus 81 +/- 10 mm in poststenotic kidney, p<0.001; CA in normal kidney 824 +/- 149 mm(2) versus 703 +/- 156 mm(2) in poststenotic kidney, p<0.01), which persisted at 6 months (ML in normal kidney 89 +/- 10 versus 80 +/- 11 in poststenotic kidney, p<0.001; CA in normal kidney 807 +/- 145 mm(2) versus 696 +/- 157 mm(2) in poststenotic kidney, p<0.01). Renal length was still within normal range in all kidneys, and the morphological parameters remained stable after revascularization.

We demonstrated significant cortical/medullary atrophy in poststenotic kidneys compared to contralateral normal kidneys. Despite intraparenchymal disease, clinical outcome was favorable after revascularization. Cortical/medullary thinning appears to be an early marker of renal ischemia that could support revascularization in FMD disease.