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Atherosclerotic ischemic renal disease
E Moscaritolo1, G Coen, S Calabria
1Renal Pathophysiology and Hypertension Unit, Chair of Nephrology, La Sapienza University, Rome, Italy.
Summary
Screening for renal artery stenosis in elderly patients with hypertension or renal failure is crucial. Color-duplex ultrasonography is an effective, non-invasive method for diagnosing this condition, which is common in older adults.
Area of Science:
- Nephrology
- Vascular Medicine
- Diagnostic Imaging
Background:
- Atherosclerotic ischemic renal disease is a leading cause of end-stage renal failure in the elderly.
- Prevalence data often relies on invasive autopsy or retrospective arteriographic studies.
- Large-scale, non-invasive screening for ischemic nephropathy has been lacking.
Purpose of the Study:
- To evaluate the prevalence of renal artery stenosis in hypertensive and/or chronically renal insufficient patients over 50.
- To assess the diagnostic accuracy of non-invasive techniques, particularly color-duplex sonography.
- To determine the association between renal artery stenosis and renal insufficiency in this population.
Main Methods:
- A cohort of 269 patients (age >50) with hypertension and/or chronic renal failure was studied.
- Color-flow duplex sonography (n=238) and renal scintigraphy (n=224) were employed; 199 patients had both.
- Confirmatory angiography (MRA/DSA) was performed on selected patients with suspected stenosis.
Main Results:
- Color-duplex sonography detected renal artery stenosis in 49 of 238 patients (20.6%), with 91.7% sensitivity and 90.9% specificity.
- Angiography confirmed stenosis in 33 of 35 evaluated patients.
- Prevalence increased with age: 11% (50-59), 18% (60-69), and 23% (≥70).
- Patients with stenosis had higher renal insufficiency but similar proteinuria levels.
Conclusions:
- Renal artery stenosis is prevalent in the elderly with hypertension/renal insufficiency, posing a risk for end-stage renal failure.
- Color-duplex ultrasonography is a validated, routine method for screening at-risk populations.
- Early detection via non-invasive imaging can identify individuals for potential intervention.