Liang F, Hu D Y, Wu M Y, Li T C, Tang C Z, Wang J Y, Lu C L
Department of Cardiology, Daxing Hospital, Capital University of Medical Science, Beijing, People's Republic of China.
Indian J Nephrol. 2012 Jan;22(1):13-7. doi: 10.4103/0971-4065.91181.
Multivessel coronary disease or peripheral arterial disease is the clinical clue to diagnosis of renal artery stenosis (RAS). RAS is considered equivalent to coronary artery disease in terms of cardiovascular risk. In this study, we evaluated the incidence of RAS in the patients who were proposed to undergo coronary artery bypass grafting (CABG). Diagnostic evaluations of coronary arteriography and renal artery angiography were performed during the same procedure; the patients who were proposed for CABG in terms of CAD anatomy and clinical manifestation were enrolled. RAS was evaluated and a diameter stenosis of ≥50% was considered as significant RAS; significant RAS patients were divided into five groups. The five groups of RAS were as follows: (1) unilateral RAS ≥50-70%, (2) unilateral RAS ≥70%, (3) bilateral RAS ≥50-70%, (4) one-renal-artery stenosis ≥50-70%, contralateral RAS ≥70%, and (5) bilateral renal artery stenosis ≥70%. A total of 151 patients were enrolled, and RAS (≥50% stenosis in either or both renal arteries) was identified in 47.02% (71/151) patients. Unilateral RAS ≥50-70% was identified in 16.6% (25/151) patients, unilateral RAS ≥70% in 4.6% (7/151) patients, bilateral RAS ≥50-70% in 7.9% (12/151) patients, one-renal-artery stenosis ≥50-70% and contralateral RAS ≥70% in 7.9% (12/151) patients, and bilateral RAS ≥70% was in 9.9%(15/151) patients. The incidence of RAS was 29.03% (18/62) in patients aged ≤60 years, 60% (36/60) in patients aged >60 and ≤70 years, and 58.62% (17/29) in patients aged >70 years. The incidence of RAS was significantly higher in patients aged >60 - ≤70, and >70 years than patients aged ≤60 years (P = 0.001 and P = 0.007, respectively). There was a trend that the incidence of RAS in patients with hypertension [HTN, 50.40% (64/127)] was higher than those without HTN (29.17%, 7/24), with P = 0.056. The incidence of RAS was 47.02% in patients who were proposed for CABG; bilateral RAS of ≥70% was 9.9%. Older age and HTN were associated with RAS in patients who were referred for CABG. This study indicates that the incidence of RAS was high in the patients referred for CABG, and the renal function should be taken care of.
多支冠状动脉疾病或外周动脉疾病是诊断肾动脉狭窄（RAS）的临床线索。就心血管风险而言，RAS被认为等同于冠状动脉疾病。在本研究中，我们评估了拟行冠状动脉旁路移植术（CABG）患者中RAS的发生率。在同一手术过程中进行冠状动脉造影和肾动脉造影的诊断评估；根据CAD解剖结构和临床表现拟行CABG的患者被纳入研究。对RAS进行评估，直径狭窄≥50%被视为显著RAS；显著RAS患者被分为五组。RAS的五组情况如下：（1）单侧RAS≥50 - 70%，（2）单侧RAS≥70%，（3）双侧RAS≥50 - 70%，（4）一侧肾动脉狭窄≥50 - 70%，对侧RAS≥70%，以及（5）双侧肾动脉狭窄≥70%。共纳入151例患者，47.02%（71/151）的患者被确诊为RAS（单侧或双侧肾动脉狭窄≥50%）。16.6%（25/151）的患者为单侧RAS≥50 - 70%，4.6%（7/151）的患者为单侧RAS≥70%，7.9%（12/151）的患者为双侧RAS≥50 - 70%，7.9%（12/151）的患者为一侧肾动脉狭窄≥50 - 70%且对侧RAS≥70%，9.9%（15/151）的患者为双侧RAS≥70%。年龄≤60岁的患者中RAS发生率为29.03%（18/62），年龄＞60岁且≤70岁的患者中为60%（36/60），年龄＞70岁的患者中为58.62%（17/29）。年龄＞60 - ≤70岁和＞70岁患者的RAS发生率显著高于年龄≤60岁的患者（分别为P = 0.001和P = 0.007）。有一个趋势是，高血压（HTN）患者的RAS发生率[50.40%（64/127）]高于无高血压患者（29.17%，7/24），P = 0.056。拟行CABG患者的RAS发生率为47.02%；双侧RAS≥70%的发生率为9.9%。年龄较大和HTN与拟行CABG患者的RAS相关。本研究表明，拟行CABG患者中RAS发生率较高，应关注肾功能。
