Abstract: FR-PO576
Clinical and Histopathologic Features of Atherosclerotic Renal Artery Stenosis (ARAS): An Autopsy Study
Session Information
- Hypertension: Clinical and Translational
November 03, 2017 | Location: Hall H, Morial Convention Center
Abstract Time: 10:00 AM - 10:00 AM
Category: Hypertension
- 1106 Hypertension: Clinical and Translational - Secondary Causes
Authors
- Chengappa, Madhuri, Mayo clinic, Rochester, Minnesota, United States
- Saad, Ahmed, Mayo Clinic, Rochester, Minnesota, United States
- Herrmann, Sandra, Mayo Clinic, Rochester, Minnesota, United States
- Grande, Joseph P., Mayo Foundation for Medical Research, Rochester, Minnesota, United States
Background
ARAS is frequently seen in ageing population and contributes to morbidity in this group. Although a number of cohort studies have compared medical versus surgical therapies for ARAS, there are no previous autopsy-based studies correlating histopathologic and clinical features in patients with ARAS.
Methods
We queried Mayo Clinic database for autopsy cases with known diagnosis of ARAS between 1994 and 2013. We obtained 19 cases for which renal and cardiac histopathology slides were available.
6 patients had unilateral(UL) ARAS (4 medically managed, 2 stented) and 13 patients had bilateral(BL) ARAS (10 medically managed, 2 stented and 1 endarterectomy). All patients were treated for hypertension. Average systolic blood pressure (SBP) was 142mmHg. There was no significant difference SBP in BL or UL ARAS patients.
Results
Histopathology findings:
Smaller kidney size correlated with increased SBP (p=0.02). There was a strong correlation with stenotic kidney(STK) size and corresponding STK weight(p=0.03). Glomerular filtration rate correlated with contralateral kidney(CLK) weight(p=0.01). STK/CLK weight ratio was significantly different between patients with UL(0.4) versus BL ARAS (0.7, p=0.002).
Glomerular size strongly correlated with atrophy and kidney weight(p=0.0006). Intrarenal vascular disease correlated with glomerulosclerosis(GS) in both STK and CLK (p=0.004 and p=0.02 respectively). All patients with UL ARAS had medullary necrosis, only 1 patient with BL ARAS had medullary necrosis. Although 1 patient had atheroembolic disease documented, we identified 5 cases of intrarenal atheroemboli. Atheroemboli were not associated with presence of abdominal aortic aneurysms, but all 19 patients had severe aortic atherosclerosis.
Outcome:
Intrarenal vascular disease correlated with cardiovascular outcome making cardiovascular the most common cause of death in these patients. 57% of patients died either due to cardiovascular cause or stroke. All 19 patients had history of severe ischemic heart disease. 10.5% of patients developed end stage renal disease(ESRD) and died due to complications of ESRD.
Conclusion
Intrarenal vascular disease is a marker of severe atrophy and GS. Small glomerular size in STK was a robust marker of compensatory hypertrophy of CLK. Atheroembolic renal disease is an under-recognized complication of ARAS in this population.