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Q J Med 1999; 92: 515-518
© 1999 Association of Physicians

Proteinuria in atherosclerotic renovascular disease

A.D. Makanjuola, M. Suresh1, P. Laboi1, P.A. Kalra1 and J.E. Scoble

From the Department of Nephrology and Transplantation, Guy's Hospital, London, and 1 Department of Nephrology, Hope Hospital, Salford, UK

Received 19 March 1999 and in revised form 17 June 1999

Dr A.D. Makanjuola, Department of Nephrology and Transplantation, Guy's Hospital, London SE1 9RT

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.


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