Renal artery stenosis: under-diagnosed and under-treated in the cardiac patient?

nary population. This is a very important subject since there are now a lot of cardiologists starting to perform renal artery procedures. There is a unique population of cardiologists that deals with the renal artery stenosis problem. This has been an interest of ours for several years. One of the first studies to examine the prevalence of renal artery stenosis in patients undergoing cardiac catheterization was done by Harding et al. Their study focused on 1,302 of 1,651 consecutive patients catheterized in a 5 month period where antero-posterior aortography was used to screen for renal artery stenosis. Ninety-five percent of these patients were deemed technically adequate to assess the presence of renal artery stenosis. There was some degree of renal disease present in 30% of that population. Fifteen percent of these patients were less than 50% stenosed, but 15% were more than 50% stenosed, out of which 11% were unilateral and 4% were bilateral. There is a direct relationship between the severity of coronary disease and the presence of significant renal artery stenosis; patients with 1-vessel disease had a 10% incidence of renal artery stenosis, those with 2-vessel disease had 20% incidence, and those with 3-vessel disease had a 30% incidence of renal artery stenosis. Forty percent of patients with left main disease were found to have some degree of renal artery stenosis. Univariate predictors of renal artery stenosis are peripheral vascular disease and age. There is an interesting relationship between congestive heart failure and renal artery stenosis and the presence of elevated creatinine. The multivariate predictors of renal artery disease and peripheral vascular disease are age, extent of coronary artery disease, congestive heart failure and female sex.