Proteinuria in atherosclerotic renovascular disease

QJM. 1999 Sep;92(9):515-8. doi: 10.1093/qjmed/92.9.515.

Abstract

Proteinuria is well described in atherosclerotic renovascular disease (ARVD), but the prevalence is unknown, and the pathogenesis may vary between patients. Substantial proteinuria (> 2 g/day) however, would be regarded by many as atypical of ARVD. We studied 94 patients (52 male) with ARVD, median age 67 years (range 49-87). Digital subtraction angiography was performed on all patients. Protein was assayed in 24-h urine samples and GFR derived using the Cockroft-Gault formula. Forty-nine patients (52%) had proteinuria < 0.5 g/24 h. Proteinuria increased with worsening renal function. Biopsies from seven non-diabetic patients with substantial proteinuria showed: minimal changes (1); glomerular sclerosis with marked ischaemic changes (3); focal glomerulosclerosis (2); and athero-emboli (1). Proteinuria, rather than being indicative of other pathology, is often a marker of severity of parenchymal disorder in atherosclerotic nephropathy, which itself is the major determinant of renal dysfunction in patients with ARVD.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Analysis of Variance
  • Arteriosclerosis / complications*
  • Arteriosclerosis / pathology
  • Arteriosclerosis / physiopathology
  • Female
  • Glomerular Filtration Rate
  • Humans
  • Hypertension, Renovascular / etiology*
  • Hypertension, Renovascular / pathology
  • Hypertension, Renovascular / physiopathology
  • Kidney / pathology
  • Male
  • Middle Aged
  • Proteinuria / etiology*
  • Proteinuria / pathology
  • Proteinuria / physiopathology
  • Renal Artery / pathology