[PP.17.33] RENAL ARTERY DISSECTION: CAUSES AND FOLLOW-UP OF 61 CASES. (September 2017)

• Record Type: Journal Article
• Authors: Faucon, A.; Bobrie, G.; Azarine, A.; Jannot, As; Azizi, M.; Amar, L.
• Is Part Of: Journal of hypertension. Volume 35(2017)Supplement 2
• Publication Date: 2017-09
• Subjects: Hypertension -- Periodicals; Hypertension -- Periodicals; 616.132005
• DOI: 10.1097/01.hjh.0000523666.51506.be
• Languages: English
• ISSNs: 1473-5598

Abstract

Abstract : Objective: Renal infarction related to renal artery dissection (RAD) is a rare entity. The aim of this study is to analyze the clinical characteristics and dissection recurrence of patients with RAD. Design and method: Between 2000 and 2015, 91 consecutive patients with renal infarction related to RAD were retrospectively identified in our Unit. Clinical and biological characteristics were extracted from our clinical data warehouse. Renal imaging was reviewed by two readers unaware of the diagnosis. In case of discrepancy, the final diagnosis was made by a vascular radiologist after a third independent reading. Results: Of 91 initially identified patients, 9 were excluded owing to a lack of imaging or clinical data, 10 were excluded because of iatrogenic (n = 6) or post-trauma complication (n = 4), and 11 were excluded because of limited sample size (aortic dissection (n = 5), dissecting aneurysm (n = 4), atherosclerosis disease (n = 1), Ehlers Danlos disease (n = 1)). The 61 remaining patients had dissecting hematoma (DH)(n = 35), fibromuscular dysplasia (FMD) (n = 16) or "dissecting or aneurysmal multifocal arterial disease" (DAAD) (n = 10). At diagnosis, median age was 46 [40;54] years, 70.5% were males, 43% had known hypertension for 9 [5;15] years, 6.5% diabetes, 34% had never smoke. The diurnal ambulatory BP was 138 [127;149] / 89 [81;98] mmHg with 2.8 [1;6] antihypertensive drugs. Serum creatinine was 89 [76;107] μmol/L. RAD involved the right kidney in 17 (28%), the left in 20 (33%) and both in 24 (39%) patients. Patients received antiplatelet drug in 66%, anticoagulant drug in 3% and 14% were treated by angioplasty. After 51 [19;92] month follow-up, the diurnal ambulatory BP was 127 [121;133] / 84 [78;87] mmHg with 2 [1;3] antihypertensive drugs. Serum creatinine was 87 [78;102] μmol/L. Dissection of other arterial sites or RAD recurrence were more frequent in FMD (60% and 31%) and DAAD (70% and 40%), than in DH (11% and 9%) (p < 0.001 and p = 0.03) respectively. Conclusions: In this large retrospective case-series, RAD was more frequently due to DH than FMD or DAAD, but dissection of other arterial sites or RAD recurrence were more frequent in FMD and in DAAD groups than in patients with DH.