4 months while 12.8% of patients with unilateral high grade stenosis had a rise in serum creatinine over an average follow-up period of 40.1 months.14 Stenosis to the entire renal mass was found to be associated with higher baseline creatinine and greater likelihood of clinical deterioration. In a cross-sectional study involving a cohort of patients from the Cardiovascular Health Study, Edwards et al. analysed the association between ARVD and excretory renal insufficiency.15 The presence of ARVD showed an association with renal insufficiency (odds learn more ratio 2.21; 95% confidence interval: 1.02–4.79; P = 0.043) that was independent of effects of age, race, sex, body weight and diabetic status.

The prospective

multicentre observational study by Pillay et al. in 2002 recruited patients with a >50% RAS from patients undergoing angiography for peripheral vascular disease. A total of 159 renal arteries in 85 patients with such stenoses were followed up by renal ultrasound over a mean period of 30 months. Renal length and BP were stable. A significant increase in serum creatinine was noted in the survivors of unilateral disease without intervention.16 The finding of declining renal function in patients with unilateral Neratinib solubility dmso ARVD suggests that intrinsic parenchymal disease, rather than the disease of the large renal arteries is the major determinant of declining renal function in this population. This hypothesis was supported by an elegant prospective study by Farmer et al. that looked at the relationship between presence of RAS and single kidney glomerular filtration rate (SK-GFR) using radionuclide studies in 79 patients with ARVD. The study noted a similar

impairment of renal function in kidneys with and without ARVD while kidneys with occluded renal buy Lumacaftor arteries were associated with significant reduction in function compared with the contralateral kidney. It was concluded that unilateral ARVD could not only compromise ipsilateral SK-GFR by ischemic mechanisms but also contralateral SK-GFR by non-ischemic mechanisms.17 The study by Losito et al. reported on 195 patients with ARVD over an average follow up of 54 months.18 Of the total, 54 were maintained on medical management, with 38.8% on an ACE inhibitor as one of the many antihypertensives in the medical treatment arm. During the period of follow up, the mean change in creatinine in the medically treated arm was an increase of 108 µmol/L. When worsening renal function was examined by Losito et al. two factors were found to be significant by multivariate analysis. The first was an abnormal baseline creatinine (>128 µmol/L) with a hazard ratio of 1.42. The second was the use of an ACE inhibitor which was associated with a reduced risk of further impairment of renal function (hazard ratio of 0.29), more pronounced in the medically treated arm.