Renal artery stenosis is an important cause of hypertension and renal failure. The most common disease process that results in renal artery stenosis is atherosclerosis. Detection of renal artery lesions by noninvasive means has been a difficult problem, and until recently invasive arteriography was the only reliable method. However, during the past few years, ultrasonic duplex scanning has emerged as an accurate technique for screening patients who are considered to be at risk for renal artery disease. In addition, this same noninvasive approach can be used for serial follow-up of these patients to document the changes that occur in the renal arteries over time. An important issue which has never been rigorously addressed is the natural history of renal artery lesions. It is currently unknown whether renal artery stenoses are likely to progress, what the rate of progression might be, and whether renal artery occlusion is a significant possibility. The status of renal function and renal mass associated with renal artery stenosis are also important considerations. It is estimated that up to 100,000 patients per year will develop ischemic renal failure secondary to progressive bilateral renal artery atherosclerosis. The investigators point out that if the risk and rate of disease progression in the renal arteries could be defined, it would be a major accomplishment that could have significant implications for patient management. The proposed project will initiate long-term follow-up studies in patients with documented renal artery stenosis. This will be accomplished by the use of duplex scanning at 6 to 12 month intervals. The status of the renal arteries, renal size, renal function, and clinical data regarding blood pressure control and risk factors for atherosclerosis will be monitored. These data will be analyzed to determine the rate of renal artery disease progression and the value of specific clinical variables as predictors of disease progression. The observed changes in renal artery disease severity will also be correlated with the severity of arterial occlusive disease in the carotid and lower extremity circulations.

Agency
National Institute of Health (NIH)
Institute
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
Type
Research Project (R01)
Project #
1R01DK048088-01A1
Application #
2148152
Study Section
Epidemiology and Disease Control Subcommittee 2 (EDC)
Project Start
1994-08-01
Project End
1998-07-31
Budget Start
1994-08-01
Budget End
1995-07-31
Support Year
1
Fiscal Year
1994
Total Cost
Indirect Cost
Name
University of Washington
Department
Surgery
Type
Schools of Medicine
DUNS #
135646524
City
Seattle
State
WA
Country
United States
Zip Code
98195
Morellato, C; Bergelin, R O; Cantwell-Gab, K et al. (2001) Clinical and duplex ultrasound follow-up after balloon angioplasty for atherosclerotic renal artery stenosis. Vasc Surg 35:85-93
Tullis, M J; Caps, M T; Zierler, R E et al. (1999) Blood pressure, antihypertensive medication, and atherosclerotic renal artery stenosis. Am J Kidney Dis 33:675-81
Caps, M T; Zierler, R E; Polissar, N L et al. (1998) Risk of atrophy in kidneys with atherosclerotic renal artery stenosis. Kidney Int 53:735-42
Caps, M T; Perissinotto, C; Zierler, R E et al. (1998) Prospective study of atherosclerotic disease progression in the renal artery. Circulation 98:2866-72
Zierler, R E; Bergelin, R O; Polissar, N L et al. (1998) Carotid and lower extremity arterial disease in patients with renal artery atherosclerosis. Arch Intern Med 158:761-7
Tullis, M J; Zierler, R E; Caps, M T et al. (1998) Clinical evidence of contralateral renal parenchymal injury in patients with unilateral atherosclerotic renal artery stenosis. Ann Vasc Surg 12:122-7
Tullis, M J; Zierler, R E; Glickerman, D J et al. (1997) Results of percutaneous transluminal angioplasty for atherosclerotic renal artery stenosis: a follow-up study with duplex ultrasonography. J Vasc Surg 25:46-54
Zierler, R E; Bergelin, R O; Davidson, R C et al. (1996) A prospective study of disease progression in patients with atherosclerotic renal artery stenosis. Am J Hypertens 9:1055-61