Occlusion of unilateral stenosed renal arteries--relation to medical treatment

In 78 patients we studied retrospectively the occurrence of occlusion in unilateral renal artery stenosis during antihypertensive drug treatment. Complete occlusion occurred in 14 patients (18%). In a multivariate analysis the following characteristics were included: blood pressure, aetiology of the stenosis, serum creatinine, the degree of the stenosis, anti-hypertensive medication, standing renal vein renin ratio and age. In this analysis the combination of a diuretic and an ACE-inhibitor, during the observation period, showed an independent relation to the development of an occlusion (P less than 0.05). Also the ACE-inhibitor alone showed a relation (P = 0.06). In the 14 patients who developed an occlusion only three showed a significant rise in serum creatinine. We conclude that special attention should be given to the follow-up of patients with renal artery stenosis who have ACE-inhibitors in their treatment regimen, especially when in combination with a diuretic.