Incidence of Renal Artery Stenosis in Hypertensive Patients Undergoing Coronary Angiography

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Abstract
To assess the frequency of renal artery stenosis in patients with hypertension and/or renal insufficiency undergoing coronary angiography, screening abdominal aortography was performed in 118 patients with a history of hypertension and/or renal insufficiency. Single plane cine abdominal angiography was performed immediately following routine coronary angiography utilizing 20–40 mL of 76% renografin. Abdominal angiography was adequate for interpretation in 116 and 118 (98%) patients. One hundred and two patients had hypertension, two had renal insufficiency, and 12 patients had hypertension and renal insufficiency. Renal artery stenosis (> 50%) was present in 27 of 116 patients (23%); 18 of 102 (18%) hypertensive patients, and 9 of 14 (67%) renal insufficiency patients. Significant renal artery stenosis was present in 22 of 76 (29%) patients with significant coronary artery disease while only 5 of 40 (10%) patients without coronary artery disease had significant renal artery stenosis. There were 10 small kidneys, five in association with renal artery stenosis; one in a patient with hypertension but without renal artery stenosis or renal insufficiency; four (two pairs) in patients with renal insufficiency but no renal artery stenosis. In conclusion: (1) significant renal artery stenosis was identified in 23% of patients with hypertension and/or renal insufficiency suggesting that more vigorous consideration of renal artery stenosis may be appropriate in hypertensive patients with coronary artery disease, and (2) abdominal angiography in conjunction with coronary angiography appears to be a useful screening test for renal artery stenosis in patients with hypertension and/or renal insufficiency.