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[Atherosclerosis and the kidney].

Alain Meyrier1

  • 1Service de néphrologie et INSERM U-430, université Paris-Descartes, faculté de médecine, hôpital européen Georges-Pompidou AP-HP, 20 rue Leblanc, 75015 Paris cedex 15, France. alain.meyrier@brs.ap-hop-paris.fr

Nephrologie & Therapeutique
|August 10, 2006
PubMed
Summary

Atherosclerotic renal artery stenosis (ARAS) affects 15-30% of patients with diffuse atherosclerosis. Early detection and risk-benefit assessment for revascularization are crucial for managing this condition and preventing complications.

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Area of Science:

  • Cardiovascular Medicine
  • Nephrology
  • Vascular Surgery

Context:

  • Diffuse atherosclerosis frequently involves renal arteries, posing a significant risk for atherosclerotic renal artery stenosis (ARAS).
  • Renal artery stenosis can lead to ischemia, activating the renin-angiotensin-aldosterone system and potentially compromising renal function under antihypertensive treatment.
  • Clinical suspicion for ARAS is raised by renal asymmetry, flash pulmonary edemas, and characteristic findings on imaging studies like ultrasonography and CT angiography.

Purpose:

  • To review the diagnostic modalities for ARAS, including imaging techniques and noninvasive methods like pulsed echo-doppler.
  • To discuss the indications and outcomes of revascularization procedures for ARAS, emphasizing the benefit-risk assessment.
  • To highlight the occurrence and diagnostic challenges of renal cholesterol crystal embolism (CCE) as a complication of atherosclerotic disease and interventions.

Summary:

  • Pulsed echo-doppler is the preferred noninvasive method for evaluating ARAS, assessing stenosis progression, and predicting functional improvement after revascularization based on the resistance index.
  • Renal arteriography, while carrying risks like cholesterol crystal embolism, is essential for angioplasty and stent placement in non-atrophic kidneys.
  • Renal cholesterol crystal embolism (CCE) presents as a severe condition mimicking vasculitis, diagnosed through clinical, laboratory, and biopsy findings, with recent treatments showing improved outcomes.

Impact:

  • Accurate diagnosis and appropriate management of ARAS can potentially preserve renal function and reduce cardiovascular morbidity.
  • Understanding the risks associated with interventions and the natural history of ARAS is vital for patient management.
  • Recognition and timely treatment of CCE can significantly improve prognosis in patients with atherosclerotic disease.

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