Hypertension And Renal Function Impairment In Low-Grade Renal Artery Stenosis

Objective: after the disappointing results of the stent trials, a certain nihilism has entered the diagnostic workup of Atherosclerotic Renal Artery Stenosis (ARAS). However, by nature, no improvement could have been expected in the end stage atherosclerotic disease, which we believe severe ARAS represents. In current conception of clinically relevant renal artery stenosis, there is no consensus on a threshold for stenosis severity. Nonetheless, in guidelines for revascularization emphasis remains on severe (>70%) renal artery stenosis. Data supporting this approach are scarce. We hypothesize that renal artery stenosis is associated with hypertension and impaired renal function disease long before reaching a threshold of 70% stenosis. Design and method: in this retrospective single centre cohort, 382 patients who underwent CTA (CT scanning-angiography) were included. Their scans were reviewed and they were categorized as having no-, mild (1–30%, moderate (31–70%) or severe (>71%) renal artery stenosis. Their medical records were scrutinized to determine information about hypertension, number of antihypertensive drugs, renal function and medical history of cardiovascular disease. Results: moderate renal artery stenosis is associated with a greater prevalence of hypertension (83%) than mild stenosis (65%) or no stenosis (41%). In concordance, eGFR is lower in moderate stenosis (68 ml/min) than mild stenosis (76 ml/min) or no stenosis (77 ml/min). Conclusions: these results show that moderate renal artery stenosis is associated with a greater hypertension prevalence and more renal impairment. Considering this and keeping in mind that severe ARAS represents end stage atherosclerotic disease, we argue that moderate renal artery stenosis should be considered for revascularization. In moderate renal artery stenosis, effects of stenting combined with medical therapy could be more pronounced and may exert more longstanding effects.