Prognosis of renal artery stenosis
What are the long term outcomes of patients with renal artery stenosis?
Most of the patients with atherosclerotic renal artery stenosis die of cardiovascular disease before ever developing end stage kidney disease (ESKD). Potential reasons for this increased burden of cardiovascular disease in patients with atherosclerotic renal artery stenosis include the presence of atherosclerosis in other vascular beds, excessive activation of the renin-angiotensin-aldosterone and sympathetic nervous systems, and the coexistence of chronic kidney disease. Mortality rates and incidence of ESKD in atherosclerotic renal artery stenosis depend on the populations examined. For example, in some older cohorts, mortality was reported to be as high 32% at 2 years and 45% at 5 years. However, in more recent randomized controlled trials published within the past 10 years Angioplasty and Stenting for Renal Artery Lesions (ASTRAL) trial, Cardiovascular Outcomes in Renal Atherosclerotic Lesions (CORAL) trial, STent placement and blood pressure and lipid-lowering for the prevention of progression of renal dysfunction caused by Atherosclerotic ostial stenosis of the Renal artery (STAR) trial) comparing medical therapy alone to stenting with medical therapy in patients with atherosclerotic renal artery stenosis, mortality was reported to be approximately 8% at 2 years and then ranged between 14% and 26% over approximately 5 years of follow-up. In contrast, the percentage of patients with atherosclerotic renal artery stenosis requiring dialysis in observational studies ranged from approximately 3% at 2 years to 12% at 5 years. In the more recent randomized controlled trials involving atherosclerotic renal artery stenosis, approximately 2% to 10% of patients with atherosclerotic renal artery stenosis started chronic dialysis over approximately a 5-year period. Kidney failure as a result of fibromuscular dysplasia is felt to be very rare.
