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NDT Advance Access published online on September 2, 2005
Nephrology Dialysis Transplantation, doi:10.1093/ndt/gfi083
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© The Author [2005]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For Permissions, please email: journals.permissions@oupjournals.org
Received May 11, 2005
Accepted July 25, 2005

Original Articles

Relationship between renal artery stenosis and intrarenal damage in autopsy subjects with stroke

Hideki Fujii 1, Satoko Nakamura 1*, Setsuko Kuroda 1, Fumiki Yoshihara 1, Hajime Nakahama 1, Takashi Inenaga 1, Hatsue Ueda-Ishibashi 2, Chikao Yutani 2, and Yuhei Kawano 1

1 Division of Hypertension and Nephrology, Department of Medicine, National Cardiovascular Center, Suita, Osaka, Japan
2 Department of Pathology, National Cardiovascular Center, Suita, Osaka, Japan

* To whom correspondence should be addressed.
Satoko Nakamura, E-mail: snakamur{at}hsp.ncvc.go.jp



  Abstract

Background. In patients with cardiovascular disease (CVD), renal dysfunction is a risk factor for the prognosis, but substantial evidence is still lacking about the relationship between clinical characteristics and renal histology. The aim of our study was to evaluate the relationship between the extent of renal parenchymal damage, renal artery stenosis (RAS) and clinical characteristics in autopsy subjects with stroke.

Methods. During the 17-year period 1980-1997, 2167 subjects were autopsied at the National Cardiovascular Center. We studied retrospectively all the autopsy cases aged 40 years and older who had a history of stroke. Thus, 346 subjects remained and they were classified into two groups. Thirty-six subjects had RAS (group A). Three hundred and ten subjects had no RAS, and we randomly chose 102 subjects among them (group B). We evaluated renal parenchymal damage using a semi-quantitative chronic damage score.

Results. The average overall chronic damage score was significantly higher in the stenosed kidneys of group A than in the non-stenosed kidneys of group B (9.0±2.6 vs 7.0±2.7). The contralateral kidneys of group A had a tendency to have milder renal damage than stenosed kidneys. Furthermore, the total score was higher in the subjects with hypertension, diabetes mellitus, proteinuria, renal insufficiency and CVD than in the subjects without such complications. The total score had a significant association with RAS, proteinuria, renal insufficiency, CVD and weight of the kidney.

Conclusions. In autopsy subjects with stroke, we demonstrated that co-existing renal parenchymal damage was more severe in the subjects with RAS, hypertension, diabetes mellitus, proteinuria and renal insufficiency than those without such complications. The presence of RAS, impaired renal function and proteinuria was closely correlated with the severity of renal parenchymal damage.

Keywords: atherosclerosis; autopsy; chronic damage score; renal artery stenosis; stroke.
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