Background/Aims: Renal artery stenosis (RAS) is a known cause of secondary hypertension and renal failure. Although renal artery angiography is the gold standard for diagnosing RAS, a simple method to estimate if patients will develop RAS is required. The aim of this retrospective study was to develop a simple risk score to predict significant RAS. Methods: Four thousand one hundred seventy-seven patients who underwent renal angiography between 2002 and 2016 at Tehran Heart Center were included. Significant RAS was defined as narrowing of the renal artery by at least 70%. Multiple predictors of the RAS were determined using multivariable logistic regression with a backward elimination method. The scoring system obtained from the final model was presented as nomogram. The possible nonlinear effect of continuous variables was evaluated using restricted cubic splines. Overfitting of the final model was assessed applying the tenfold cross-validation method. Model performance was checked using calibration plot as well as Hosmer-Lemeshow goodness of fit test, and area under the receiver operating characteristics (ROC) curve. Results: The prevalence of RAS was 14.1%. Female sex (OR [95% CI]: 1.53 [1.26–1.85]), hypertension (OR [95% CI]: 1.38 [1.08–1.77]), estimated glomerular filtration rate (OR [95% CI]: 0.98 [0.97–0.98]), body mass index (OR [95% CI]: 0.97 [0.95–0.99]), and age (OR [95% CI]: 1.01 [1.00–1.02]) were determined as the multiple predictors of RAS. The area under the ROC curve of the final predictive model was 0.702 (95% CI: 0.679–0.725). Conclusion: This model assesses the risk of RAS using available information. This model can be used for both clinical and research purposes.

1.
Gafoor S, Franke J, Sievert H: The CORAL trial, round 2. J Am Coll Cardiol 2015; 66: 2495–2497.
2.
Mailloux LU, Bellucci AG, Mossey RT, Napolitano B, Moore T, Wilkes BM, Bluestone PA: Predictors of survival in patients undergoing dialysis. Am J Med 1988; 84: 855–862.
3.
Khan IH, Catto GR, Edward N, Fleming LW, Henderson IS, MacLeod AM: Influence of coexisting disease on survival on renal-replacement therapy. Lancet 1993; 341: 415–418.
4.
Appel RG, Bleyer AJ, Reavis S, Hansen KJ: Renovascular disease in older patients beginning renal replacement therapy. Kidney Int 1995; 48: 171–176.
5.
Scoble JE, Maher ER, Hamilton G, Dick R, Sweny P, Moorhead JF: Atherosclerotic renovascular disease causing renal impairment-a case for treatment. Clin Nephrol 1989; 31: 119–122.
6.
Piccoli G, Salomone M, Quarello F, Piccoli GB, Verzetti G, Ramello A, Magistroni P: Regional registry of dialysis and transplantation of Piedmont, Italy (RPDT). Thirteen years of experience. Regional registry of dialysis and transplantation. Nephrol Dial Transplant 1995; 10: 444–447.
7.
Zucchelli P, Zuccala A: Ischemic nephropathy. J Nephrol 1999; 12:S152–S160.
8.
Preston RA, M E: Ischemic renal disease: an emerging cause of chronic renal failure and end-stage renal disease. J Hypertens 1997; 15(12 pt 1): 1365–1377.
9.
Textor SC, Lerman L: Renovascular hypertension and ischemic nephropathy. Am J Hypertens 2010; 23: 1159–1169.
10.
Schwartz CJ, White TA: Stenosis of renal artery: an unselected necropsy study. Br Med J 1964; 2: 1415–1421.
11.
Sawicki PT, Kaiser S, Heinemann L, Frenzel H, Berger M: Prevalence of renal artery stenosis in diabetes mellitus – an autopsy study. J Intern Med 1991; 229: 489–492.
12.
Holley KE, Hunt JC, Brown AL Jr, Kincaid OW, Sheps SG: Renal artery stenosis. A clinical-pathologic study in normotensive and hypertensive patients. Am J Med 1964; 37: 14–22.
13.
Harding MB, Smith LR, Himmelstein SI, Harrison K, Phillips HR, Schwab SJ, Hermiller JB, Davidson CJ, Bashore TM: Renal artery stenosis: prevalence and associated risk factors in patients undergoing routine cardiac catheterization. J Am Soc Nephrol 1992; 2: 1608–1616.
14.
Greco BA, Breyer JA: Atherosclerotic ischemic renal disease. Am J Kidney Dis 1997; 29: 167–187.
15.
Connolly JO, Higgins RM, Walters HL, Mackie AD, Drury PL, Hendry BM, Scoble JE: Presentation, clinical features and outcome in different patterns of atherosclerotic renovascular disease. QJM 1994; 87: 413–421.
16.
Rihal CS, Textor SC, Breen JF, McKusick MA, Grill DE, Hallett JW, Holmes DR Jr: Incidental renal artery stenosis among a prospective cohort of hypertensive patients undergoing coronary angiography. Mayo Clin Proc 2002; 77: 309–316.
17.
Mailloux LU, Napolitano B, Bellucci AG, Vernace M, Wilkes BM, Mossey RT: Renal vascular disease causing end-stage renal disease, incidence, clinical correlates, and outcomes: a 20-year clinical experience. Am J Kidney Dis 1994; 24: 622–629.
18.
Fatica RA, Port FK, Young EW: Incidence trends and mortality in end-stage renal disease attributed to renovascular disease in the United States. Am J Kidney Dis 2001; 37: 1184–1190.
19.
van Ampting JM, Penne EL, Beek FJ, Koomans HA, Boer WH, Beutler JJ: Prevalence of atherosclerotic renal artery stenosis in patients starting dialysis. Nephrol Dial Transplant 2003; 18: 1147–1151.
20.
Rimmer JM, Gennari FJ: Atherosclerotic renovascular disease and progressive renal failure. Ann Intern Med 1993; 118: 712–719.
21.
Herrera AH, Davidson RA: Renovascular disease in older adults. Clin Geriatr Med 1998; 14: 237–254.
22.
Valderrabano F, Berthoux FC, Jones EH, Mehls O: Report on management of renal failure in Europe, XXV, 1994 end stage renal disease and dialysis report. The EDTA-ERA Registry. European Dialysis and Transplant Association-European Renal Association. Nephrol Dial Transplant 1996; 1: 2–21.
23.
Lao D, Parasher PS, Cho KC, Yeghiazarians Y: Atherosclerotic renal artery stenosis – diagnosis and treatment. Mayo Clin Proc 2011; 86: 649–657.
24.
Kaul A, Vardhan H: Ischemic nephropathy. Clin Queries Nephrol 2012; 1: 268–278.
25.
Levey AS, Stevens LA, Schmid CH, et al: A new equation to estimate glomerular filtration rate. Ann Intern Med 2009; 150: 604–612.
26.
Harrell FEJ: Regression Modeling Strategies with Applications to Linear Models, Logistic and Ordinal Regression and Survival Analysis (ed 2). New York, Springer-Verlag, 2015.
27.
Luque-Fernandez MA, Maringe C, Nelson P: CVAUROC: Stata module to compute Cross-validated Area Under the Curve for ROC Analysis after Predictive Modelling for Binary Outcomes. In Statistical Software Components S458324, Boston College Department of Economics, revised 22 Nov 20172017.
28.
Zlotnik A AV: A general-purpose nomogram generator for predictive logistic regression models. Stata J 2015; 15: 537–546.
29.
Salame M, Padulla GA, Muradás RR, Machado G, Braun SK, dos Santos KB, Mussio AV, KonopkaCL: Ischemic nephropathy. J Vasc Bras 2012; 11: 310–316.
30.
Xue JL, Ma JZ, Louis TA, Collins AJ: Forecast of the number of patients with end-stage renal disease in the United States to the year 2010. J Am Soc Nephrol 2001; 12: 2753–2758.
31.
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(1N): 46N–51N.
32.
Louie J, Isaacson JA, Zierler RE, Bergelin RO, Strandness DE Jr: Prevalence of carotid and lower extremity arterial disease in patients with renal artery stenosis. Am J Hypertens 1994; 7: 436–439.
33.
Kuroda S, Nishida N, Uzu T, Takeji M, Nishimura M, Fujii T, Nakamura S, Inenaga T, Yutani C, Kimura G: Prevalence of renal artery stenosis in autopsy patients with stroke. Stroke 2000; 31: 61–65.
34.
Adamczak M, Wiecek A: Ischemic nephropathy – pathogenesis and treatment. Nefrologia 2012; 32: 432–438.
35.
Krijnen P, van Jaarsveld BC, Steyerberg EW, Man in ‘t Veld AJ, Schalekamp MA, Habbema JD: A clinical prediction rule for renal artery stenosis. Ann Intern Med 1998; 129: 705–711.
36.
Cianci R, Martina P, Gigante A, Di Donato D, Polidori L, Presta P, Labbadia R, Amoroso D, Zaccaria A, Barbano B, et al: Predictor factors for renal outcome in renal artery stenosis. Eur Rev Med Pharmacol Sci 2013; 17: 507–512.
37.
Lee Y, Shin JH, Park HC, Kim SG, Choi SI: A prediction model for renal artery stenosis using carotid ultrasonography measurements in patients undergoing coronary angiography. BMC Nephrol 2014; 15: 60.
38.
Zeng L ZZ, Yang K, Jiang F, Yuan H , Tang X, Jiang W and Wan X: Predictive factors for efficacy of catheterbased renal denervation with standard ablation catheter in refractory Hypertension. Interv Cardiol J 2017; 3(3): 67.
39.
Chronic Kidney Disease – Identification, Evaluation and Management of Adult Patients. British Columbia: Ministry of Health, 2014. https://www2.gov.bc.ca/gov/content/health/practitioner-professional-resources/bc-guidelines/chronic-kidney-disease (accessed January 2018).
40.
Alcazar JM, Marin R, Gomez-Campdera F, Orte L, Rodriguez-Jornet A, Mora-Macia J: Clinical characteristics of ischaemic renal disease. Nephrol Dial Transplant 2001; 1: 74–77.
41.
Hansen KJ, Edwards MS, Craven TE, Cherr GS, Jackson SA, Appel RG, Burke GL, Dean RH: Prevalence of renovascular disease in the elderly: a population-based study. J Vascular Surg 2002; 36: 443–451.
42.
Rokni N, Salarifar M, Hakki Kazaz E, Goodarzynejad H: Frequency and predictors of renal artery stenosis in patients undergoing simultaneous coronary and renal catheterization. J Tehran Heart Cent 2012; 7: 58–64.
43.
Textor S, Lerman L: State of the art: renovascular hypertension and ischemic nephropathy. Am j hypertens 2010; 23: 1159–1169.
44.
Buller CE, Nogareda JG, Ramanathan K, Ricci DR, Djurdjev O, Tinckam KJ, Penn IM, Fox RS, Stevens LA, Duncan JA, et al: The profile of cardiac patients with renal artery stenosis. J Am Coll Cardiol 2004; 43: 1606–1613.
45.
Zoccali C, Mallamaci F, Finocchiaro P: Atherosclerotic renal artery stenosis: epidemiology, cardiovascular outcomes, and clinical prediction rules. J Am Soc Nephrol 2002; 13(suppl 3):S179–S183.
46.
Alhaddad IA BS, Heller EN, et al: Renal artery stenosis in minority patients undergoing diagnostic cardiac catheterization: prevalence and risk factors. J Cardiovasc Pharmacol Ther 2001; 6: 147–153.
47.
Leandri M, Lipiecki J, Lipiecka E, et al: [Prevalence of renal artery stenosis in patients undergoing cardiac catheterization: when should abdominal aortography be performed? Results in 467 patients]. J Radiol 2004; 85: 627–633.
48.
Ollivier R, Boulmier D, Veillard D, Leurent G, Mock S, Bedossa M, Le Breton H: Frequency and predictors of renal artery stenosis in patients with coronary artery disease. Cardiovasc Revasc Med 2009; 10: 23–29.
49.
Cohen MG, Pascua JA, Garcia-Ben M, Rojas-Matas CA, Gabay JM, Berrocal DH, Tan WA, Stouffer GA, Montoya M, Fernandez AD, et al: A simple prediction rule for significant renal artery stenosis in patients undergoing cardiac catheterization. Am Heart J 2005; 150: 1204–1211.
50.
Khatami MR, Edalati-Fard M, Sadeghian S, Salari-Far M, Bs MP: Renal artery stenosis in patients with established coronary artery disease: prevalence and predicting factors. Saudi J Kidney Dis Transpl 2014; 25: 986–989.
51.
Sadeghi N SS, Abbasi Mood Z, Karimi A: Determinants of operative mortality following primary coronary artery bypasss. Eur J Cardiothorac Surg 2002; 21: 187–192.
52.
Textor SC: Atherosclerotic renal artery stenosis: flaws in estimated glomerular filtration rate and the problem of progressive kidney injury. Circ Cardiovasc Interv 2011; 4: 213–215.
53.
Gosset J, Olin JW: Atherosclerotic renovascular disease: clinical clues and natural history. J Endovasc Ther 1997; 4: 316–320.
54.
Burlacu A, Siriopol D, Voroneanu L, Nistor I, Hogas S, Nicolae A, Nedelciuc I, Tinica G, Covic A: Atherosclerotic renal artery stenosis prevalence and correlations in acute myocardial infarction patients undergoing primary percutaneous coronary interventions: data from nonrandomized single-center study (REN-ACS)-a single center, prospective, observational study. J Am Heart Assoc 2015; 4:e002379.
55.
Ramirez G, Bugni W, Farber SM, Curry AJ: Incidence of renal artery stenosis in a population having cardiac catheterization. South Med J 1987; 80: 734–737.
56.
de Silva R, Loh H, Rigby AS, Nikitin NP, Witte KKA, Goode K, Bhandari S, Nicholson A, Clark AL, Cleland JGF: Epidemiology, associated factors, and prognostic outcomes of renal artery stenosis in chronic heart failure assessed by magnetic resonance angiography. Am J Cardiol 2007; 100: 273–279.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.