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QJM Advance Access originally published online on February 7, 2009
QJM 2009 102(4):283-288; doi:10.1093/qjmed/hcp007
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© The Author 2009. Published by Oxford University Press on behalf of the Association of Physicians. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Proteinuria as a predictor of renal functional outcome after revascularization in atherosclerotic renovascular disease (ARVD)

C. Chrysochou1, C.M. Cheung1, M. Durow1, R.J. Middleton1, L.R. Solomon2, A. Craig2, M. Venning3 and P.A. Kalra1

From the 1Department of Renal Medicine, Salford Royal Hospital, Salford, UK, 2Department of Renal Medicine, Royal Preston Hospital, Preston, UK and 3Department of Nephrology, Central Manchester and Manchester Children's Hospital, Infirmary, Manchester, UK

Address correspondence to C. Chrysochou, Department of Renal Medicine, Salford Royal Hospital, Salford, UK. email: tinachrys{at}doctors.org.uk

Received 3 October 2008 and in revised form 11 January 2009


  Abstract

Backround: Renal revascularization is performed in 16% of newly diagnosed patients with atherosclerotic renovascular disease (ARVD). Although there may be some improvement in hypertension control as a result of intervention, renal functional outcomes are known to vary. Pre-existing renal parenchymal injury, as manifested by proteinuria, is associated with poor functional outcome in conservatively managed ARVD patients, but this association has not been investigated in patients undergoing revascularization.

Methods: Retrospective case note review of 83 ARVD patients who underwent renal revascularization in four centres within a renal network between 1998 and 2003 was undertaken. Amongst other parameters, baseline proteinuria was correlated with renal functional outcome post revascularization. Renal functional outcome was determined over a mean follow up of 22 months by rate of change of estimated glomerular filtration rate (eGFR) over time.

Results: Univariate analysis showed that proteinuria >0.6 g/day was the only significant predictor of poor outcome after revascularization. The relationship persisted with multivariate analysis, and linear regression showed a correlation between baseline proteinuria and decline in eGFR with time (r2 = 0.058, P = 0.039).

Conclusion: This study confirms that prior renal parenchymal injury, here reflected by proteinuria at baseline, is a major arbiter of renal functional outcome after renal revascularization in ARVD.


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