Park Sungha, Jung Jae-Hun, Seo Hye-Sun, Ko Young-Guk, Choi Donghoon, Jang Yangsoo, Chung Namsik, Cho Seung Yun, Shim Won-Heum
Division of Cardiology, Yonsei Cardiovascular Center, Yonsei University College of Medicine, Seodaemun-gu, Shinchondong, Seoul 120-752, South Korea.
Heart Vessels. 2004 Nov;19(6):275-9. doi: 10.1007/s00380-004-0789-1.
Renal artery stenosis is an important cause of secondary hypertension as well as ischemic nephropathy. The purpose of this study was to determine the clinical predictors in patients with renal artery stenosis in a population referred for coronary angiography. From March 1998 to July 1999, 1459 patients undergoing coronary angiography for various indications were routinely screened for renal artery stenosis by undergoing abdominal aortography. Coronary angiography, carotid angiography, and abdominal aortography was performed via either the radial or the femoral approach. The data were analyzed retrospectively. Out of 1459 patients undergoing abdominal aortography, 158 (10.8%) were found to have significant renal artery stenosis with 24 of the patients having bilateral stenosis. Significant coronary artery diseases were found in 994 of the 1459 study population (68.1%), with 134 (13.5%) of these patients having concomitant renal artery stenosis. Multivariate logistic regression showed that extracranial carotid artery stenosis odds ratio [(OR) 4.89 (95% confidence interval 2.57-9.33), P < 0.001], peripheral artery disease [OR 4.64 (2.65-9.33), P < 0.001], renal insufficiency [OR 2.68 (1.43-5.02), P = 0.002], significant coronary artery disease [OR 2.01 (1.12-3.59), P = 0.019], hypercholesterolemia [OR 1.92 (1.07-3.43), P = 0.028], hypertension [OR 1.85 (1.16-2.95), P = 0.010], and old age (> 60 years) [OR 1.64 (1.01-2.64), P = 0.044] were significant clinical predictors of renovascular disease. The prevalence of indolent atherosclerotic renal artery stenosis is relatively high in selected groups of patients with high clincial risk factors for this underdiagnosed disease. Renal artery stenosis should be highly suspected in patients who have these risk factors because early detection of this disease may reverse the progression to chronic renal failure and end-stage renal disease.
肾动脉狭窄是继发性高血压以及缺血性肾病的重要病因。本研究的目的是确定因冠状动脉造影而转诊的肾动脉狭窄患者的临床预测因素。1998年3月至1999年7月，对1459例因各种适应证接受冠状动脉造影的患者常规行腹主动脉造影以筛查肾动脉狭窄。冠状动脉造影、颈动脉造影和腹主动脉造影均通过桡动脉或股动脉途径进行。对数据进行回顾性分析。在1459例行腹主动脉造影的患者中，158例（10.8%）发现有显著肾动脉狭窄，其中24例为双侧狭窄。在1459例研究人群中，994例（68.1%）发现有显著冠状动脉疾病，其中134例（13.5%）同时患有肾动脉狭窄。多因素logistic回归显示，颅外颈动脉狭窄比值比[（OR）4.89（95%置信区间2.57 - 9.33），P < 0.001]、外周动脉疾病[OR 4.64（2.65 - 9.33），P < 0.001]、肾功能不全[OR 2.68（1.43 - 5.02），P = 0.002]、显著冠状动脉疾病[OR 2.01（1.12 - 3.59），P = 0.019]、高胆固醇血症[OR 1.92（1.07 - 3.43），P = 0.028]、高血压[OR 1.85（1.16 - 2.95），P = 0.010]和老年（> 60岁）[OR 1.64（1.01 - 2.64），P = 0.044]是肾血管疾病的显著临床预测因素。在具有该诊断不足疾病高临床危险因素的特定患者群体中，无症状性动脉粥样硬化性肾动脉狭窄的患病率相对较高。对于有这些危险因素的患者，应高度怀疑肾动脉狭窄，因为早期发现该疾病可能会逆转其向慢性肾衰竭和终末期肾病的进展。
