Appel R G, Bleyer A J, Reavis S, Hansen K J
Department of Internal Medicine, Bowman Gray School of Medicine of Wake Forest University, Winston-Salem, North Carolina, USA.
Kidney Int. 1995 Jul;48(1):171-6. doi: 10.1038/ki.1995.281.
Renovascular disease (RVD) in older patients can cause progressive renal insufficiency and even end-stage renal disease (ESRD). The frequency of this clinical problem is not well defined. Renal duplex sonography (RDS) correctly identifies the presence of RVD with an overall accuracy of approximately 95%. Therefore, the purpose of this study was to utilize RDS as a noninvasive tool to identify the presence of critical RVD (> or = 60% diameter-reducing stenosis or occlusion) in patients 50 years of age or older beginning renal replacement therapy. A total of 53 consecutive participating patients were prospectively interrogated. Complete interrogations occurred in 45 of the 53 patients (85%), and 92 of the 103 kidneys (89%). Critical RVD was noted in 10 of 45 patients (22%). RVD was bilateral in 5 patients, unilateral in 5 patients, and there were 4 renal artery occlusions noted. All patients with critical RVD were white (10 of 25 white patients or 40%). Total pack years of smoking as well as associated cardiovascular and cerebrovascular conditions were greater in those patients with critical RVD compared to those without. These results indicate that RDS remains technically feasible as renal blood flow and function decline. Unsuspected RVD possibly contributory to renal insufficiency exists in a significant number of primarily white patients 50 years of age or older beginning renal replacement therapy. These patients are generally smokers with a high frequency of associated extrarenal atherosclerosis The addition of RVD as a separate category of disease causing ESRD would improve U.S. Renal Data System ESRD classification. RVD should be recognized as a cause of ESRD.
老年患者的肾血管疾病（RVD）可导致进行性肾功能不全，甚至终末期肾病（ESRD）。这一临床问题的发生率尚未明确界定。肾双功超声检查（RDS）能正确识别RVD的存在，总体准确率约为95%。因此，本研究的目的是利用RDS作为一种非侵入性工具，来识别50岁及以上开始肾脏替代治疗的患者中是否存在严重RVD（直径缩小≥60%的狭窄或闭塞）。共有53例连续参与的患者接受了前瞻性检查。53例患者中有45例（85%）完成了全部检查，103个肾脏中有92个（89%）完成了检查。45例患者中有10例（22%）发现存在严重RVD。RVD为双侧的有5例患者，单侧的有5例患者，还发现4例肾动脉闭塞。所有患有严重RVD的患者均为白人（25例白人患者中有10例，即40%）。与无严重RVD的患者相比，有严重RVD的患者的吸烟总包年数以及相关的心血管和脑血管疾病情况更为严重。这些结果表明，随着肾血流和功能下降，RDS在技术上仍然可行。在大量50岁及以上开始肾脏替代治疗的主要为白人的患者中，存在可能导致肾功能不全的未被怀疑的RVD。这些患者通常为吸烟者，伴有肾外动脉粥样硬化的频率较高。将RVD作为导致ESRD的一种单独疾病类别纳入，将改善美国肾脏数据系统的ESRD分类。RVD应被视为ESRD的一个病因。
