Abstract 3117: Atheroembolic Disease in Renal Artery Stenosis: Clinical and Pathological Correlates
Background: While the presence of atheroembolic disease has been established in elderly patients with renal artery stenosis, its clinical relevance remains unknown. The objective of this study was to correlate the pathological evidence of atheroembolism and clinical characteristics in selected patients who underwent nephrectomy of their small kidneys for resistant renovascular hypertension.
Methods: We performed an observational retrospective study in 77 patients who underwent nephrectomy of small kidney for uncontrolled hypertension between 1990 and 2000.
Results: The mean age of the patients was 60 ± 16 years; 31 (42%) were men. Eighty one percent of patients had atherosclerosis as the underlying cause for renal artery stenosis; 10% had fibromuscular dysplasia. Thirty percent of patients had renal histopathologic evidence of atheroembolic disease. Atheroemboli were more prevalent in renal sections of patients with atherosclerotic renal artery stenosis compared to non-atherosclerotic renal artery disease (36.5% vs. 7%, respectively, P <0.03). Patients with histo-pathological evidence of atheroemboli, compared to those without, were older, (mean age of 66 ± 9 years vs. 58 ± 16 years, P<0.04), and had a higher prevalence of abdominal aortic aneurysm (45% vs. 17%, P<0.01). Also, there was a trend for positive association between atheroembolic disease and coronary artery disease, peripheral vascular disease, smoking, and hyperlipidemia (P = 0.05 – 0.1). The presence of atheroemboli was associated with smaller kidneys (average size of 7.5 ± 2.0 cm vs. 8.4 ± 2.0 cm, P <0.02) and worse renal function (creatinine clearance of 34 ± 16 ml/min vs. 50 ± 21 ml/min, P<0.003).
Conclusion: Our results suggest that elderly patients with abdominal aortic aneurysm and functionally significant atherosclerotic disease of the renal arteries are at greater risk for renal atheroembolic disease. In these patients, the presence of atheroemboli is associated with a greater degree of renal dysfunction and more extensive atrophy.