Renal artery stenosis in cardio- and cerebrovascular disease - Renal duplex ultrasonography as an initial screening examination

Abstract

Background: The prevalence and indicative clinical factors of renal artery stenosis (RAS) in the Japanese population are unclear. Methods and Results: The aim of this study was to investigate the prevalence of RAS in a selectively referred Japanese population and to determine any clinical factors related to RAS by initially screening with renal duplex ultrasonography. The 750 patients presenting because of possible or known cardio- and cerebrovascular diseases were prospectively studied. Duplex examination was performed in 729 patients (97.2%): 21 patients (2.8%) did not undergo it, because of technical impossibility. Duplex RAS was found in 38 patients (5.2%). Subsequently, a confirmatory renal angiography was obtained in 40 patients, investigating those who had duplex RAS or no duplex examination. Angiographic RAS was found in 35 patients (4.8%). The respective prevalences of duplex and angiographic RAS were 6.3% and 6.7% in coronary artery disease, 8.8% and 9.3% in multivessel coronary artery disease, 7.5% and 8.2% in heart failure, 5.1% and 4.3% in unstable angina pectoris, 20.0% and 22.2% in carotid artery stenosis, 10.3% and 10.2% in stroke, 20.0% and 20.0% in peripheral artery disease, and 12.0% and 11.8% in abdominal aortic aneurysm. Univariate analysis showed that patients with duplex RAS were older and had more atherosclerotic risk factors. Furthermore, they were more likely to be smokers and have hypertension, renal impairment, renal atrophy, left ventricular hypertrophy and cardio- and cerebrovascular diseases. Multivariate stepwise analysis showed that smoking, peripheral artery disease, abdominal aortic aneurysm and renal atrophy were independent predictors of duplex RAS. Conclusions: RAS is frequent in Japanese patients with cardio- and cerebrovascular diseases. Initial screening for RAS by duplex ultrasonography is recommended for patients with complications, especially peripheral artery disease, abdominal aortic aneurysm and renal atrophy.