Krishnamurthi V, Novick A C, Myles J L
Department of Urology, Cleveland Clinic Foundation, Ohio, USA.
J Urol. 1999 Apr;161(4):1093-6. doi: 10.1016/s0022-5347(01)61598-2.
Atheroembolic renal disease is increasingly found in older patients with general atherosclerosis. We evaluated the impact of atheroembolic renal disease on morbidity and survival after surgical revascularization for atherosclerotic renal artery stenosis.
The study group comprised 44 patients who underwent surgical revascularization for atherosclerotic renal artery stenosis and concomitant intraoperative renal biopsy. Renal biopsy specimens were reviewed by a pathologist and evaluated for the presence or absence of atheroemboli, and the presence and severity of arteriolar nephrosclerosis. Postoperative patient data were reviewed to evaluate survival, and the incidence of renal and systemic morbid events. Patients were followed for 1 to 14.5 years (median 6.2) after surgical revascularization.
Atheroembolic renal disease was identified in the intraoperative biopsy specimen in 16 patients (36%, group 1) and was absent in 28 (64%, group 2), termed groups 1 and 2. Atheroembolic renal disease correlated significantly with decreased patient survival. The 5-year survival in groups 1 and 2 was 54 and 85%, respectively (p = 0.011). Similarly the incidence of systemic atherosclerotic complications was significantly higher in group 1 than group 2 (86 versus 58%, p <0.05). In addition, renal or renovascular complications developed in more group 1 than group 2 patients (p = 0.07). There was no significant association between the presence or severity of arteriolar nephrosclerosis and postoperative survival or morbid events.
Our results indicate that atheroembolic renal disease is associated with decreased survival and an increased incidence of atherosclerotic morbid events after surgical revascularization for atherosclerotic renal artery stenosis. This information may be useful for therapeutic decision making in patients with atherosclerotic renal artery stenosis.
动脉粥样硬化栓塞性肾病在患有全身性动脉粥样硬化的老年患者中越来越常见。我们评估了动脉粥样硬化栓塞性肾病对动脉粥样硬化性肾动脉狭窄手术血运重建后发病率和生存率的影响。
研究组包括44例因动脉粥样硬化性肾动脉狭窄接受手术血运重建并在术中进行肾活检的患者。肾活检标本由病理学家复查，评估是否存在动脉粥样硬化栓子，以及小动脉性肾硬化的存在情况和严重程度。回顾术后患者数据以评估生存率以及肾脏和全身不良事件的发生率。患者在手术血运重建后随访1至14.5年（中位时间6.2年）。
术中活检标本中16例患者（36%，第1组）发现动脉粥样硬化栓塞性肾病，28例患者（64%，第2组）未发现，分别称为第1组和第2组。动脉粥样硬化栓塞性肾病与患者生存率降低显著相关。第1组和第2组的5年生存率分别为54%和85%（p = 0.011）。同样，第1组全身性动脉粥样硬化并发症的发生率显著高于第2组（86%对58%，p <0.05）。此外，第1组发生肾脏或肾血管并发症的患者多于第2组（p = 0.07）。小动脉性肾硬化的存在或严重程度与术后生存率或不良事件之间无显著关联。
我们的结果表明，动脉粥样硬化栓塞性肾病与动脉粥样硬化性肾动脉狭窄手术血运重建后生存率降低和动脉粥样硬化不良事件发生率增加相关。该信息可能有助于动脉粥样硬化性肾动脉狭窄患者的治疗决策。
