Renal artery stenosis epidemiology and demographics: Difference between revisions
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Renal artery stenosis considered a disease of the elderly.<ref name="pmid11172181">{{cite journal| author=Safian RD, Textor SC| title=Renal-artery stenosis. | journal=N Engl J Med | year= 2001 | volume= 344 | issue= 6 | pages= 431-42 | pmid=11172181 | doi=10.1056/NEJM200102083440607 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11172181 }} </ref> It most commonly affects patients with cardiovascular co-morbidities, such as those with diabetes mellitus, coronary and peripheral artery disease, dyslipidemia, essential hypertension, and smoking history.<ref name="pmid2045754">{{cite journal| author=Sawicki PT, Kaiser S, Heinemann L, Frenzel H, Berger M| title=Prevalence of renal artery stenosis in diabetes mellitus--an autopsy study. | journal=J Intern Med | year= 1991 | volume= 229 | issue= 6 |pages= 489-92 | pmid=2045754 | doi= | pmc= |url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2045754 }} </ref><ref name="pmid7305653">{{cite journal| author=Dean RH, Kieffer RW, Smith BM, Oates JA, Nadeau JH, Hollifield JW et al.| title=Renovascular hypertension: anatomic and renal function changes during drug therapy. | journal=Arch Surg | year= 1981 | volume= 116 | issue= 11 | pages= 1408-15 | pmid=7305653 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7305653 }} </ref><ref name="pmid1880841">{{cite journal| author=Tollefson DF, Ernst CB| title=Natural history of atherosclerotic renal artery stenosis associated with aortic disease. | journal=J Vasc Surg | year= 1991 | volume= 14 | issue= 3 | pages= 327-31 | pmid=1880841 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1880841 }} </ref><ref name="pmid9812088">{{cite journal| author=Crowley JJ, Santos RM, Peter RH, Puma JA, Schwab SJ, Phillips HR et al.| title=Progression of renal artery stenosis in patients undergoing cardiac catheterization. | journal=Am Heart J | year= 1998 | volume= 136 | issue= 5 | pages= 913-8 | pmid=9812088 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9812088 }} </ref> It is difficult to assess the real incidence and prevalence of renal artery stenosis because most patients with the disease are in fact asymptomatic. As such, the disease prevalence is underestimated.<ref name="pmid19907044">{{cite journal| author=Dworkin LD, Cooper CJ| title=Clinical practice. Renal-artery stenosis. | journal=N Engl J Med | year= 2009 | volume= 361 | issue= 20 | pages= 1972-8 | pmid=19907044 | doi=10.1056/NEJMcp0809200 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19907044 }} </ref> In a study that involved 14,152 patients undergoing abdominal aortography, approximately 10% of the patients had RAS and 1.3% had bilateral RAS, 60% of which were considered significant stenoses.<ref name="pmid9812088">{{cite journal| author=Crowley JJ, Santos RM, Peter RH, Puma JA, Schwab SJ, Phillips HR et al.| title=Progression of renal artery stenosis in patients undergoing cardiac catheterization. | journal=Am Heart J | year= 1998 | volume= 136 | issue= 5 | pages= 913-8 | pmid=9812088 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9812088 }} </ref> Autopsy findings among 5194 patients between 1980 and 1988 showed that 4.3% of all patients RAS, most of which were not diagnosed.<ref name="pmid2045754">{{cite journal| author=Sawicki PT, Kaiser S, Heinemann L, Frenzel H, Berger M| title=Prevalence of renal artery stenosis in diabetes mellitus--an autopsy study. | journal=J Intern Med | year= 1991 | volume= 229 | issue= 6 | pages= 489-92 | pmid=2045754 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2045754 }} </ref> The frequency of RAS among patients with diabetes and hypertension was higher, reaching up to 10% of all patients. <ref name="pmid2045754">{{cite journal| author=Sawicki PT, Kaiser S, Heinemann L, Frenzel H, Berger M| title=Prevalence of renal artery stenosis in diabetes mellitus--an autopsy study. | journal=J Intern Med | year= 1991 | volume= 229 | issue= 6 | pages= 489-92 | pmid=2045754 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2045754 }} </ref> Bilateral renal artery stenosis was higher in diabetic patients, but significant association was not reached in the study.<ref name="pmid2045754">{{cite journal| author=Sawicki PT, Kaiser S, Heinemann L, Frenzel H, Berger M| title=Prevalence of renal artery stenosis in diabetes mellitus--an autopsy study. | journal=J Intern Med | year= 1991 | volume= 229 | issue= 6 | pages= 489-92 | pmid=2045754 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2045754 }} </ref> | Renal artery stenosis considered a disease of the elderly.<ref name="pmid11172181">{{cite journal| author=Safian RD, Textor SC| title=Renal-artery stenosis. | journal=N Engl J Med | year= 2001 | volume= 344 | issue= 6 | pages= 431-42 | pmid=11172181 | doi=10.1056/NEJM200102083440607 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11172181 }} </ref> It most commonly affects patients with cardiovascular co-morbidities, such as those with diabetes mellitus, coronary and peripheral artery disease, dyslipidemia, essential hypertension, and smoking history.<ref name="pmid2045754">{{cite journal| author=Sawicki PT, Kaiser S, Heinemann L, Frenzel H, Berger M| title=Prevalence of renal artery stenosis in diabetes mellitus--an autopsy study. | journal=J Intern Med | year= 1991 | volume= 229 | issue= 6 |pages= 489-92 | pmid=2045754 | doi= | pmc= |url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2045754 }} </ref><ref name="pmid7305653">{{cite journal| author=Dean RH, Kieffer RW, Smith BM, Oates JA, Nadeau JH, Hollifield JW et al.| title=Renovascular hypertension: anatomic and renal function changes during drug therapy. | journal=Arch Surg | year= 1981 | volume= 116 | issue= 11 | pages= 1408-15 | pmid=7305653 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7305653 }} </ref><ref name="pmid1880841">{{cite journal| author=Tollefson DF, Ernst CB| title=Natural history of atherosclerotic renal artery stenosis associated with aortic disease. | journal=J Vasc Surg | year= 1991 | volume= 14 | issue= 3 | pages= 327-31 | pmid=1880841 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1880841 }} </ref><ref name="pmid9812088">{{cite journal| author=Crowley JJ, Santos RM, Peter RH, Puma JA, Schwab SJ, Phillips HR et al.| title=Progression of renal artery stenosis in patients undergoing cardiac catheterization. | journal=Am Heart J | year= 1998 | volume= 136 | issue= 5 | pages= 913-8 | pmid=9812088 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9812088 }} </ref> It is difficult to assess the real incidence and prevalence of renal artery stenosis because most patients with the disease are in fact asymptomatic. As such, the disease prevalence is underestimated.<ref name="pmid19907044">{{cite journal| author=Dworkin LD, Cooper CJ| title=Clinical practice. Renal-artery stenosis. | journal=N Engl J Med | year= 2009 | volume= 361 | issue= 20 | pages= 1972-8 | pmid=19907044 | doi=10.1056/NEJMcp0809200 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19907044 }} </ref> In a study that involved 14,152 patients undergoing abdominal aortography, approximately 10% of the patients had RAS and 1.3% had bilateral RAS, 60% of which were considered significant stenoses.<ref name="pmid9812088">{{cite journal| author=Crowley JJ, Santos RM, Peter RH, Puma JA, Schwab SJ, Phillips HR et al.| title=Progression of renal artery stenosis in patients undergoing cardiac catheterization. | journal=Am Heart J | year= 1998 | volume= 136 | issue= 5 | pages= 913-8 | pmid=9812088 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9812088 }} </ref> Autopsy findings among 5194 patients between 1980 and 1988 showed that 4.3% of all patients RAS, most of which were not diagnosed.<ref name="pmid2045754">{{cite journal| author=Sawicki PT, Kaiser S, Heinemann L, Frenzel H, Berger M| title=Prevalence of renal artery stenosis in diabetes mellitus--an autopsy study. | journal=J Intern Med | year= 1991 | volume= 229 | issue= 6 | pages= 489-92 | pmid=2045754 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2045754 }} </ref> The frequency of RAS among patients with diabetes and hypertension was higher, reaching up to 10% of all patients. <ref name="pmid2045754">{{cite journal| author=Sawicki PT, Kaiser S, Heinemann L, Frenzel H, Berger M| title=Prevalence of renal artery stenosis in diabetes mellitus--an autopsy study. | journal=J Intern Med | year= 1991 | volume= 229 | issue= 6 | pages= 489-92 | pmid=2045754 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2045754 }} </ref> Bilateral renal artery stenosis was higher in diabetic patients, but significant association was not reached in the study.<ref name="pmid2045754">{{cite journal| author=Sawicki PT, Kaiser S, Heinemann L, Frenzel H, Berger M| title=Prevalence of renal artery stenosis in diabetes mellitus--an autopsy study. | journal=J Intern Med | year= 1991 | volume= 229 | issue= 6 | pages= 489-92 | pmid=2045754 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2045754 }} </ref> | ||
Atherosclerotic renal artery stenosis affects approximately 0.5-7% of the U.S. population above the age of 65 years. It is present in almost 5% of patients with chronic kidney disease. | Atherosclerotic renal artery stenosis affects approximately 0.5-7% of the U.S. population above the age of 65 years. It is present in almost 5% of patients with chronic kidney disease.<ref name="pmid15954920">{{cite journal| author=Kalra PA, Guo H, Kausz AT, Gilbertson DT, Liu J, Chen SC et al.| title=Atherosclerotic renovascular disease in United States patients aged 67 years or older: risk factors, revascularization, and prognosis. | journal=Kidney Int | year= 2005 | volume= 68 | issue= 1 | pages= 293-301 | pmid=15954920 | doi=10.1111/j.1523-1755.2005.00406.x | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15954920 }} </ref><ref name="pmid12218965">{{cite journal| author=Hansen KJ, Edwards MS, Craven TE, Cherr GS, Jackson SA, Appel RG et al.| title=Prevalence of renovascular disease in the elderly: a population-based study. | journal=J Vasc Surg | year= 2002 | volume= 36 | issue= 3 | pages= 443-51 | pmid=12218965 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12218965 }} </ref> Although stenosis may progress in 30-53% of patients within only 2-5 years. after diagnosis, only 3-15% of patient with ARAS progress to total occlusion of the renal arteries.<ref name="pmid1880841">{{cite journal| author=Tollefson DF, Ernst CB| title=Natural history of atherosclerotic renal artery stenosis associated with aortic disease. | journal=J Vasc Surg | year= 1991 | volume= 14 | issue= 3 | pages= 327-31 | pmid=1880841 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1880841 }} </ref><ref name="pmid7305653">{{cite journal| author=Dean RH, Kieffer RW, Smith BM, Oates JA, Nadeau JH, Hollifield JW et al.| title=Renovascular hypertension: anatomic and renal function changes during drug therapy. | journal=Arch Surg | year= 1981 | volume= 116 | issue= 11 | pages= 1408-15 | pmid=7305653 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7305653 }} </ref><ref name="pmid1880841">{{cite journal| author=Tollefson DF, Ernst CB| title=Natural history of atherosclerotic renal artery stenosis associated with aortic disease. | journal=J Vasc Surg |year= 1991 | volume= 14 | issue= 3 | pages= 327-31 | pmid=1880841 | doi= | pmc= |url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1880841 }} </ref><ref name="pmid9507221">{{cite journal| author=Caps MT, Zierler RE, Polissar NL, Bergelin RO, Beach KW, Cantwell-Gab K et al.| title=Risk of atrophy in kidneys with atherosclerotic renal artery stenosis. | journal=Kidney Int | year= 1998 | volume= 53 | issue= 3 | pages= 735-42 | pmid=9507221 | doi=10.1046/j.1523-1755.1998.00805.x | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9507221 }} </ref><ref name="pmid9860789">{{cite journal| author=Caps MT, Perissinotto C, Zierler RE, Polissar NL, Bergelin RO, Tullis MJ et al.| title=Prospective study of atherosclerotic disease progression in the renal artery. | journal=Circulation | year= 1998 | volume= 98 | issue= 25 | pages= 2866-72 | pmid=9860789 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9860789 }} </ref> The definition of disease progression, however, may vary between individual studies. | ||
To date, there is no reliable information about the prevalence of secondary hypertension due to renal artery stenosis. Follow-up and prognosis for hypertensive patients with renal artery stenosis has not yet been achieved. | To date, there is no reliable information about the prevalence of secondary hypertension due to renal artery stenosis. Follow-up and prognosis for hypertensive patients with renal artery stenosis has not yet been achieved. | ||
==References== | ==References== | ||
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Epidemiology and demographics
Renal artery stenosis considered a disease of the elderly.[1] It most commonly affects patients with cardiovascular co-morbidities, such as those with diabetes mellitus, coronary and peripheral artery disease, dyslipidemia, essential hypertension, and smoking history.[2][3][4][5] It is difficult to assess the real incidence and prevalence of renal artery stenosis because most patients with the disease are in fact asymptomatic. As such, the disease prevalence is underestimated.[6] In a study that involved 14,152 patients undergoing abdominal aortography, approximately 10% of the patients had RAS and 1.3% had bilateral RAS, 60% of which were considered significant stenoses.[5] Autopsy findings among 5194 patients between 1980 and 1988 showed that 4.3% of all patients RAS, most of which were not diagnosed.[2] The frequency of RAS among patients with diabetes and hypertension was higher, reaching up to 10% of all patients. [2] Bilateral renal artery stenosis was higher in diabetic patients, but significant association was not reached in the study.[2]
Atherosclerotic renal artery stenosis affects approximately 0.5-7% of the U.S. population above the age of 65 years. It is present in almost 5% of patients with chronic kidney disease.[7][8] Although stenosis may progress in 30-53% of patients within only 2-5 years. after diagnosis, only 3-15% of patient with ARAS progress to total occlusion of the renal arteries.[4][3][4][9][10] The definition of disease progression, however, may vary between individual studies.
To date, there is no reliable information about the prevalence of secondary hypertension due to renal artery stenosis. Follow-up and prognosis for hypertensive patients with renal artery stenosis has not yet been achieved.
References
- ↑ Safian RD, Textor SC (2001). "Renal-artery stenosis". N Engl J Med. 344 (6): 431–42. doi:10.1056/NEJM200102083440607. PMID 11172181.
- ↑ 2.0 2.1 2.2 2.3 Sawicki PT, Kaiser S, Heinemann L, Frenzel H, Berger M (1991). "Prevalence of renal artery stenosis in diabetes mellitus--an autopsy study". J Intern Med. 229 (6): 489–92. PMID 2045754.
- ↑ 3.0 3.1 Dean RH, Kieffer RW, Smith BM, Oates JA, Nadeau JH, Hollifield JW; et al. (1981). "Renovascular hypertension: anatomic and renal function changes during drug therapy". Arch Surg. 116 (11): 1408–15. PMID 7305653.
- ↑ 4.0 4.1 4.2 Tollefson DF, Ernst CB (1991). "Natural history of atherosclerotic renal artery stenosis associated with aortic disease". J Vasc Surg. 14 (3): 327–31. PMID 1880841.
- ↑ 5.0 5.1 Crowley JJ, Santos RM, Peter RH, Puma JA, Schwab SJ, Phillips HR; et al. (1998). "Progression of renal artery stenosis in patients undergoing cardiac catheterization". Am Heart J. 136 (5): 913–8. PMID 9812088.
- ↑ Dworkin LD, Cooper CJ (2009). "Clinical practice. Renal-artery stenosis". N Engl J Med. 361 (20): 1972–8. doi:10.1056/NEJMcp0809200. PMID 19907044.
- ↑ Kalra PA, Guo H, Kausz AT, Gilbertson DT, Liu J, Chen SC; et al. (2005). "Atherosclerotic renovascular disease in United States patients aged 67 years or older: risk factors, revascularization, and prognosis". Kidney Int. 68 (1): 293–301. doi:10.1111/j.1523-1755.2005.00406.x. PMID 15954920.
- ↑ Hansen KJ, Edwards MS, Craven TE, Cherr GS, Jackson SA, Appel RG; et al. (2002). "Prevalence of renovascular disease in the elderly: a population-based study". J Vasc Surg. 36 (3): 443–51. PMID 12218965.
- ↑ Caps MT, Zierler RE, Polissar NL, Bergelin RO, Beach KW, Cantwell-Gab K; et al. (1998). "Risk of atrophy in kidneys with atherosclerotic renal artery stenosis". Kidney Int. 53 (3): 735–42. doi:10.1046/j.1523-1755.1998.00805.x. PMID 9507221.
- ↑ Caps MT, Perissinotto C, Zierler RE, Polissar NL, Bergelin RO, Tullis MJ; et al. (1998). "Prospective study of atherosclerotic disease progression in the renal artery". Circulation. 98 (25): 2866–72. PMID 9860789.