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Review: Renovascular disease in diabetic patients

Department of Endocrinology, Manchester Royal Infirmary, Manchester, UK

Philip A Kalra

Department of Renal Medicine, Hope Hospital, Salford, UK, philip.kalra{at}srht.nhs.uk

Atherosclerotic renovascular disease (ARVD) is a common condition which presents with acute or chronic renal failure, hypertension or cardiac failure. Its prevalence is high in the elderly and in those with evidence of generalised vascular disease. It is therefore common in diabetic patients, who are prone to development of generalised atherosclerotic vascular disease. The majority of diabetic patients have clinical indications that merit angiotensin-converting enzyme (ACE) inhibitor or angiotensin II receptor antagonist (AIIA) therapy, but even if ARVD is present, acute renal dysfunction will be the exception rather than the rule. Certain clinical clues should instigate a high index of suspicion for the presence of ARVD in the diabetic patient, but it does not follow that detection of anatomically significant stenoses within the renal arteries should automatically be treated by renal revascularisation. The results of Angioplasty and Stent for Renal Artery Lesions (ASTRAL), a UK multi-centre study, should hopefully guide appropriate practice in this area in the future.

Key Words: atherosclerotic renovascular disease • diabetes.

References

• Choudhri AH, Cleland JG, Rowlands PC, Tran TL, McCarthy M., Al-Kutoubi MA Unsuspected renal artery stenosis in peripheral vascular disease. BMJ 1990;301:1197-8.[Free Full Text]
• Harding MB, Smith LR, Himmelstein SI et al. Renal artery stenosis. Prevalence and associated risk factors in patients undergoing routine cardiac catherization. J Am Soc Nephrol 1992;2:1608-16.[Abstract]
• Olin JW, Melia M., Young JR, Graor RA, Risius B. Prevalence of atherosclerotic renal artery stenosis in patients with atherosclerosis elsewhere. Am J Med 1990;88:46N-51N.[CrossRef][Medline] [Order article via Infotrieve]
• Zuccala A., Losinno F., Zuchelli A., Zuchelli PC Renovascular disease in diabetes mellitus: treatment by percutaneous transluminal renal angioplasty. Nephrol Dial Transplant 1998;13:26-9.[Abstract/Free Full Text]
• Valabhji J., Robinson S., Poulter C. et al. Prevalence of renal artery stenosis in subjects with type 2 diabetes and coexistent hypertension. Diabetes Care 2000;23:539-43.[Abstract]
• Courreges JP, Bacha J., Aboud E., Pradier P. Prevalence of renal artery stenosis in type 2 diabetes. Diabetes Metab 2000;26:90-6.[Web of Science][Medline] [Order article via Infotrieve]
• Lewis EJ, Hunsicker LG, Bain RP, Rohde RD The effect of angiotensin converting enzyme inhibition on diabetic nephropathy. N Engl J Med 1993;329:1456-62.[Abstract/Free Full Text]
• The EUCLID Study Group. Randomised placebo-controlled trial of lisinopril in normotensive patients with insulin-dependent diabetes and normoalbuminuria or microalbuminuria. Lancet 1997;349:1787-92.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
• The Microalbuminuria Captopril Study Group. Captopril reduces the risk of nephropathy in IDDM patients with microalbuminuria. Diabetologia 1996;39:587-93.[Medline] [Order article via Infotrieve]
• Brenner BM, Cooper ME, de Zeeuw D. et al., for the RENAAL Study Investigators. Effects of losartan on renal and cardiovascular outcomes in patients with type 2 diabetes and nephropathy. N Engl J Med 2001; 345:861-9.[Abstract/Free Full Text]
• Lewis EJ, Hunsicker LG, Clarke WR et al., for The Collaborative Study Group. Renoprotective effect of the angiotensin-receptor antagonist irbesartan in patients with nephropathy due to type 2 diabetes. N Engl J Med 2001;345:851-60.[Abstract/Free Full Text]
• Pitt B., Segal R., Martinez M. et al., on behalf of Elite study investigators. Randomised trial of lorsartan versus captopril in patients over 65 with heart failure. (Evaluation of Lorsartan in the Elderly Study, ELITE). Lancet 1997;349:747-52.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
• Kalra PA, Mamtora H., Holmes AM, Waldek S. Renovascular disease and renal complications of angiotensin-converting enzyme inhibitor therapy. Quart J Med 1990;282:1013-18.
• Kalra PA, Kumwenda M., MacDowall P., Roland MO ACE inhibitor usage and monitoring in general practice: the need for guidelines to prevent renal failure. BMJ 1999;318:234-7.[Abstract/Free Full Text]
• Kshirsagar AV, Joy MS, Hogan SL, Falk RJ, Colindres RE Effect of ACE inhibitors in diabetic and nondiabetic chronic renal disease: a systematic overview of randomized placebo-controlled trials. Am J Kidney Dis 2000; 35:695-707.[Web of Science][Medline] [Order article via Infotrieve]
• Conlon PJ, O'Riordan E., Kalra PA New insights into the epidemiologic and clinical manifestations of atherosclerotic renovascular disease. Am J Kidney Dis 2000;35:573-87.[Web of Science][Medline] [Order article via Infotrieve]
• Schreiber MF, Pohl MA, Novick AC The natural history of atherosclerotic and fibrous renal artery disease. Urol Clin North Am 1984;11:383-92.[Web of Science][Medline] [Order article via Infotrieve]
• Zierler RE, Bergelin RO, Isaacson JA, Strandness DE Jr. Natural history of atherosclerotic renal artery stenosis: a prospective study with duplex ultrasonography. J Vasc Surg 1994;19:250-8.[Web of Science][Medline] [Order article via Infotrieve]
• Caps MT, Zierler RE, Polissar NL et al. Risk of atrophy in kidneys with atherosclerotic renal artery stenosis. Kidney Int 1998;53:735-42.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
• Textor SC Revascularisation in atherosclerotic renal artery disease. Kidney Int 1998;53:799-811.[Web of Science][Medline] [Order article via Infotrieve]
• Bonelli FS, McKusick MA, Textor SC et al. Renal artery angioplasty: technical results and clinical outcome in 320 patients. Mayo Clinic Proc 1995; 70:1041-52.[Abstract]
• Harden PN, MacLeod MJ, Rodger RSC et al. Effect of renal artery stenting on progression of renovascular renal failure. Lancet 1997;349:1133-6.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
• Hallett JW, Textor SC, Kos PB et al. Advanced renovascular hypertension and renal insufficiency: trends in medical comorbidity and surgical approach from 1970 to 1993. J Vasc Surg 1995;21:750-9.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
• Suresh M., Laboi P., Mamtora H., Kalra PA Relationship of renal dysfunction to proximal arterial disease severity in atherosclerotic renovascular disease. Nephrol Dial Transplant 2000;15:631-6.[Abstract/Free Full Text]
• Pickering TG, Herman L., Devereux RB et al. Recurrent pulmonary oedema in hypertension due to bilateral renal artery stenosis: treatment by angioplasty or surgical revascularisation. Lancet 1988;ii(8610):551-2.
• Missouris CG, Buckenham T., Vallance PJT, MacGregor GA Renal artery stenosis masquerading as congestive heart failure. Lancet 1993;341: 1521-2.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]

The British Journal of Diabetes & Vascular Disease, Vol. 2, No. 2, 91-95 (2002)
DOI: 10.1177/14746514020020020501


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This Article Abstract Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Saved Citations Download to citation manager Request Permissions Request Reprints Add to My Marked Citations Citing Articles Citing Articles via Google Scholar Citing Articles via Scopus Google Scholar Articles by Hay, C. J Articles by Kalra, P. A Search for Related Content Social Bookmarking                         What's this?