Indications for Renal Arteriography at the Time of Coronary Arteriography

Atherosclerotic renal artery stenosis is often found in patients who have peripheral arterial sclerosis (22 to 59 percent of patients) and in patients with known or suspected coronary artery disease. Atherosclerotic renal artery stenosis is associated with myocardial infarction, stroke, and death, and it can lead to occlusion or loss of renal function. The American Heart Association (AHA) published a science advisory on the indications for renal arteriography in the October 2006 issue of Circulation.

The risks and costs of screening for atherosclerotic renal artery stenosis at the time of diagnostic arteriography must be weighed against the benefits. Evidence suggests that the addition of abdominal aortography to coronary arteriography in patients with a baseline serum creatinine level of 2.0 mg per dL (180 μmol per L) or less is not associated with an increase in morbidity or mortality rates. The catheter used in the procedure is not traumatic, and the additional contrast administration is small. Patients at risk of contrast-induced nephropathy should be given acetylcysteine (Acetadote) before treatment and should receive vigorous hydration.

When possible, patients with a clinical indication for investigation of renal artery stenosis should undergo noninvasive diagnostic tests (i.e., duplex ultrasonography, magnetic resonance arteriography, or computer-assisted tomographic arteriography) before coronary arteriography.

The AHA concludes that it is reasonable to perform diagnostic screening renal arteriography at the time of cardiac catheterization when a patient is at risk of atherosclerotic renal artery stenosis and is a candidate for revascularization.