A study of renal artery stenosis among hypertensive patients in Basrah (Iraq)

Abstract

Background: Renal artery stenosis (RAS) is the most common potentially curable cause of secondary hypertension. It accounts for less than one percent of mild hypertension and 10 to 45 percent of severe or malignant hypertension. Atherosclerotic type is the most common form. Objective: To study the prevalence of renal artery stenosis among hypertensive patients with the aid of clinical criteria suggestive of the diagnosis. Patients and Methods: A cross-sectional study of patients with hypertension attended a private clinic, outpatient's clinic, emergency department, nephrology ward and coronary care unit in Basrah teaching hospital from the period of January 2010 to January 2012. Results: The study involved 27 patients with hypertension diagnosed as renal artery stenosis. Atherosclerotic RAS accounted for 77.8% of cases, while fibromuscular dysplastic RAS accounted for 22.2% of cases. The ARAS was more common in female (57.1%) and accounted for 100% of cases more than 60-year old. The FMD type was more common in female (66.7%) and accounted for 100% of cases younger than 30-year old. The most common clinical criteria suggestive for the diagnosis was unexplained renal azotemia (25.9%). Nephrotic range proteinuria was reported in 11.1% while non-nephrotic proteinuria in 51.9%. LVH was reported in 40.7%. The Doppler ultrasound was normal in 96.3. The MRA shows left proximal stenosis in 22.2%, right proximal stenosis in 33.3%, left distal stenosis in 3.7%, right distal stenosis in 18.5% and bilateral stenosis in 22.2%. Hypokalemia was reported in 70.4%. The serum cholesterol was normal in 77.8%. Conclusion: Renal artery stenosis is more common in whites and rare in blacks. The atherosclerotic type is more common and it is more common in the older age group. The fibromusculr type is more common in the younger age group. Right renal artery stenosis is more common than the left.