Related Study Of Atherosclerotic Renal Artery Stenosis In Patients With Coronary Artery Disease

Background Atherosclerotic renal artery stenosis(ARAS) is a relatively uncommom disease. It will develop to chronic atherosclerotic ischemic renal disease. This is the most important reason for end-stage renal disease(ESRD). Luckly, ARAS is a reversible course of ESRD. How to find ARAS early is important for therapeutic strategy. There are so many studies about diagnosis and treatment. It is not very clear about its associated risk factors. Many people decline that coronary heart disease(CAD) is the first important factor for ARAS. They also think ARAS is related to many risk factors of atherosclerotic disease. For determine the relationship of ARAS and CAD, we designed this study, to evaluate the related factors of ARAS.Objective To evaluate the prevalence of ARAS in patients undergoing selective coronary angiography, determine the relationship of ARAS and CAD, and to investigate the related factors of ARAS.Methods A total of 410 patients with suspected CAD underwent selective renal artery angiography immediately after coronary angiography. According to the reduction in lumen diameter of renal artery, ARAS was defined to early ARAS ( 0-30% ), mediate ARAS( 30%-50% ), and severity ARAS( ≥75% ). Independent sample test and multivariate logistic regression analysis were used to study the independent risk predictors of ARAS. Clinical data was analysed.Results 88(21.4%)patients observed with ARAS were included 30 (7.3%)patients in early, 40(9.7%) patients in mediate and 18 (4.3%) patients in severity ARAS. There were 43(10.4%)patients with bilateral stenosis, 16(3.9%)were mediate stenosis and 2(0.4%) were severity. The incidence of ARAS in 285 patients with CAD is 26.3%, including 28(9.8%) patients with early, 35 (12.3%) patients with mediate, 12 (4.2%) patients with severity. The incidenceof ARAS in 125 patients with normal coronary artery is 10.4%, including 2(1.6%) patients with early, 5(4%) patients with mediate, 6 (4.8%) patients with severity. The difference between two groups is very significant(P< 0.01). There were more multivessel and left main artery(LM) lesions found in patients with mediate and severity ARAS. 130 renal arteries were narrow more than 30% of lumen diameter. 80(61.5%) lesions were found in the ostial, 48(36.9%) lesions were found in the main stem, and 2(1.6%) lesions were found in the branch of renal artery. The prevalence of ARAS was higher in eraly renal disfunction (Scr≥100μmol/L). It was 44.4%( severity), 17.5%( mediate ) and 3.3%(early) individually. By the multivariate logistic regression analysis, it were released that the important related factors are female, hypercholesterolemia, lower high density lipoprotein(HDL), early renal disfunction , 3- vessel lesions and LM lesion in coronary arteries.Conclusions The prevalence of ARAS in pateints with CAD is 21.4%. It is useful to perform selective renal artery angiography following coronary angiography. ARAS is not parallel with CAD. Female, hypercholesterolemia, low HDL, early renal disfunction, CAD with 3- vessel lesions and LM lesion are the independently predicts risks for ARAS.