Predictors of undiagnosed renal artery stenosis among Japanese patients with risk factors of atherosclerosis
Predictors of undiagnosed renal artery stenosis among Japanese patients with risk factors of atherosclerosis
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DOI：
10.1291/hypres.28.237
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发表时间：
2005-03-01
影响因子：
5.4
通讯作者：
Ito, S
中科院分区：
文献类型：
--
作者：
Tanemoto, M;Saitoh, H;Ito, S
动脉粥样硬化性肾动脉狭窄（ARAS）是老年人终末期肾功能障碍（ESRD）的一个重要原因。虽然早期发现ARAS和诱导适当的治疗可以降低ESRD的发生率，但关于预测日本ARAS的参数的报道很少。在这项研究中，我们研究了预测动脉粥样硬化危险因素（bbb40岁+高血压、血脂异常或糖尿病）的日本人ARAS的临床指标。剔除已诊断为肾动脉狭窄的患者后，纳入202例患者。所有202例患者均行磁共振动脉造影（MRA）检查肾动脉，将肾动脉开口处直径缩小50%以上的狭窄定义为ARAS。MRA检测到ARAS 42例（31例为半侧，11例为双侧）。ARAS患者与非ARAS患者在性别分布、腹部血管赘生物检测及吸烟习惯等方面无显著差异。糖尿病、高血压和脑血管合并症的患病率也无显著差异。两组患者的平均血压、体重指数和血清总胆固醇值相似。然而，年龄、脉压、血清尿酸、血清肌酐、尿蛋白量和冠状动脉合并症在ARAS患者中显著增高，而估计的肌酐清除率在ARAS患者中显著低于无ARAS患者。高血压视网膜病变在ARAS患者中的患病率也很高。多因素分析显示，年龄和肾功能损害是日本动脉粥样硬化危险因素患者发生ARAS的独立预测因素。
Atherosclerotic renal artery stenosis (ARAS) is a significant cause of end stage renal dysfunction (ESRD) among the elderly. Although early detection of ARAS and induction of adequate treatment could reduce the incidence of ESRD, there have been few reports about parameters predictive of ARAS among Japanese. In this study, we investigated the clinical indicators that predict ARAS among Japanese with risk factors of atherosclerosis (> 40 years of age plus hypertension, dyslipidemia or diabetes mellitus). After eliminating the patients who had already been diagnosed with renal artery stenosis, 202 patients were enrolled. The renal arteries of all 202 patients were evaluated by magnetic resonance arteriography (MRA), and the stenoses with > 50% reduction in diameter at the ostium of the renal artery were defined as ARAS. MRA detected ARAS in 42 patients (31 hemilateral and 11 bilateral). Between the patients with and without ARAS there was no significant difference in gender distribution, detection of abdominal vascular bruits or smoking habit. The prevalences of diabetic, hypertensive and cerebrovascular comorbidity were also not significantly different. The mean blood pressure, body mass index and total serum cholesterol values were similar between the two groups. However, age, pulse pressure, serum uric acid, serum creatinine, amount of urinary protein, and coronary artery comorbidity were significantly higher, while estimated creatinine clearance was significantly lower in the patients with ARAS than in those without ARAS. A high prevalence of hypertensive retinopathy was also noted among patients with ARAS. Multivariate analysis revealed that older age and renal impairment were independent predictors of ARAS in Japanese patients with atherosclerotic risk factors.