A Prospective Study of Disease Progression in Patients With Atherosclerotic Renal Artery Stenosis*
Abstract
The natural history of renal artery stenosis (RAS) has been difficult to document because serial arteriography is rarely justified. Duplex scanning is a noninvasive technique that is ideally suited for both screening and follow-up of RAS. In this approach, renal arteries are classified as normal, < 60% stenosis, > or = 60% stenosis, or occluded, and disease progression is defined as a change in the duplex classification. The purpose of this study was to determine the rate of disease progression in atherosclerotic RAS by serial duplex scanning. At least one abnormal renal artery was identified in each of 76 patients being screened for RAS. Of the 152 renal arteries, 20 were excluded (14 prior interventions, 5 occlusions, 1 technically inadequate duplex scan), leaving 132 for the natural history follow-up protocol. The patient group included 36 men and 40 women, with a mean age of 67 years, who were followed for a mean of 32 months (maximum 55 months). The initial status of the 132 renal arteries was normal in 36, < 60% stenosis in 35, and > or = 60% stenosis in 61. The cumulative incidence of progression from normal to > or = 60% RAS was 0% at 1 year, 0% at 2 years, and 8% at 3 years. The cumulative incidence of progression from < 60% to > or = 60% RAS was 30% at 1 year, 44% at 2 years, and 48% at 3 years. All 4 renal arteries that progressed to occlusion had > or = 60% stenoses at the initial visit, and for those arteries with a > or = 60% stenosis, the cumulative incidence of progression to occlusion was 4% at 1 year, 4% at 2 years, and 7% at 3 years. Progression of RAS occurred at an average rate of 7% per year for all categories of baseline disease combined. Progression of atherosclerotic RAS is relatively common, particularly from < 60% to > or = 60% stenosis.
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There is an added risk for cardiovascular complications in individuals with RAS.
“However, there is also an added risk for cardiovascular complications at the same time201, 202).”
From Japan Atherosclerosis Society (JAS) guidelines for prevention of atherosclerotic cardiovascular diseases 2017 (2018) · cites this paper as [201]
Atherosclerotic Renal Artery Stenosis is a high-risk condition for ASCVD.
“[Statement]Atherosclerotic Renal Artery Stenosis Is a High-risk Condition for ASCVD. (Evidence Level: E-2)”
From Japan Atherosclerosis Society (JAS) guidelines for prevention of atherosclerotic cardiovascular diseases 2017 (2018) · cites this paper as [201]
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- Authors
- ZIERLER, R., BERGELIN, R., DAVIDSON, R., CANTWELLCAB, K., POLISSAR, N., & STRANDNESSJR, D.
- Affiliations
- University of Washington (US)
- Corresponding author
- ZIERLER, R
- Venue
- American Journal of Hypertension
- Publisher
- Oxford University Press (OUP)
- Published
- 1996-11
- Volume
- 9
- Issue
- 11
- Pages
- 1055-1061
- ISSN
- 0895-7061 (ISSN-L)
- OpenAlex
- W2111053980
- Cited by
- 217
- References
- 32
- Citations by year
- 2026: 3 · 2025: 1 · 2023: 4 · 2022: 2 · 2021: 4 · 2020: 4 · 2019: 4 · 2018: 6 · 2017: 2 · 2016: 3 · 2015: 5 · 2014: 7 · 2013: 5 · 2012: 10
- FWCI
- 12.51
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- American Journal of Hypertension (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health (5r01dk048088-04)
- National Institute of Diabetes and Digestive and Kidney Diseases (1 R01 DK48088-01A1)
- Topics
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Renal and Vascular Pathologies
- Health Sciences › Medicine › Surgery › Peripheral Artery Disease Management
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Cerebrovascular and Carotid Artery Diseases
- Keywords
- renal artery stenosis, atherosclerosis, disease progression, duplex ultrasound, renal artery occlusion, natural history (disease), hypertension
- MeSH terms
- Aged, Angioplasty, Balloon, Arteriosclerosis, Female, Follow-Up Studies, Humans, Hypertension, Renovascular, Male, Middle Aged, Nephrectomy, Prospective Studies, Renal Artery, Renal Artery Obstruction, Risk Factors, Time Factors, Incidence, Confidence Intervals, Disease Progression, Ultrasonography, Doppler, Duplex
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