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Ischemic nephropathy in an elderly nephrologic and hypertensive population
G Coen1, M Manni, M F Giannoni
1Renal Pathophysiology and Hypertension Unit, La Sapienza University, Rome, Italy.
Insights
Atherosclerotic renovascular disease is common in older adults, often leading to kidney failure. Echo-color doppler ultrasonography effectively identifies significant renal artery stenosis, a key risk factor.
Area of Science:
- Cardiology
- Nephrology
- Vascular Medicine
Background:
- Atherosclerotic renovascular disease is a primary cause of end-stage renal failure in the elderly.
- Prevalence data often relies on autopsy or retrospective arteriography.
- This study prospectively investigated patients with late-onset hypertension and/or chronic renal failure.
Purpose of the Study:
- To assess the prevalence of renal artery stenosis in elderly patients with hypertension and/or chronic renal failure.
- To evaluate the diagnostic accuracy of noninvasive imaging techniques for detecting renal artery stenosis.
- To correlate renal artery stenosis with the severity of renal insufficiency.
Main Methods:
- Prospective study of 133 elderly patients (age >50) with new-onset hypertension and/or chronic renal failure.
- Utilized echo-color doppler ultrasonography (n=104) and renal scintigraphy (n=112).
- Digital selective angiography confirmed findings in 13 patients with positive noninvasive tests.
Main Results:
- Echo-color doppler demonstrated 100% positive predictive value for significant stenosis (>50%).
- Prevalence of significant stenosis increased with age: 3.2% (50-59 yrs), 20% (60-69 yrs), 25% (>70 yrs).
- Significant stenosis correlated with higher renal insufficiency and more hypotensive medications (p < 0.013).
Conclusions:
- A significant proportion of the elderly population has renal artery stenosis, posing a risk for end-stage renal failure.
- Noninvasive echo-color doppler is highly accurate for diagnosing hemodynamically significant renal artery stenosis.
- Disease progression varies, and non-renal causes of death can influence outcomes.
Background:
Atherosclerotic renovascular disease is a frequent cause of end-stage renal failure leading to dialysis in the elderly population. Its prevalence is known from autopsy or retrospective arteriographic investigations. This prospective study was conducted in 133 subjects with the inclusion criteria of hypertension and/or chronic renal failure starting after 50 years of age. Renal failure was unrelated to other known causes of renal disease.
Methods:
The patients were subjected to echo-color doppler ultrasonography of renal arteries (104) and/or to renal scintigraphy (112). Thirteen of 27 patients with positivity using one or both noninvasive techniques were subjected to digital selective angiography.
Results:
All the patients with positivity of echo-color doppler technique were true positives, with a consequent predictive value reaching 100%. Renal scintigraphy was of markedly lower predictive value. Based on the echo-color doppler investigation, percentage positivity for hemodynamically significant stenosis (> 50%) was 3.2 (16.3% had mild nonsignificant stenosis of renal arteries) in the 50- to 59-year-old group, 20% (plus 12.5% with nonsignificant stenosis) in the 60- to 69-year-old group and 25% (plus 17.8% nonsignificant stenosis) in the > 70-year age group. Patients with significant stenosis also had a significantly higher degree of renal insufficiency and received a higher number of hypotensive drugs (p < 0.013). The percentage of hypertensive patients was not different in the stenotic and nonstenotic groups.
Conclusions:
A large percentage of the elderly population is affected by renal vascular obstructive disease and is at risk of developing end-stage renal failure. Considering the wide number of cases with foreseeable renal arterial stenosis in the vast population meeting the selection criteria, it is possible to conclude that not all cases evolve to renal failure due to different rates of progression or to untimely nonrenal death.