Renal artery stenosis in the antiphospholipid (Hughes) syndrome and hypertension.

ABSTRACT

BACKGROUND: Hypertension is common in the antiphospholipid (Hughes) syndrome (APS) and its cause is poorly understood. Anecdotal evidence suggests that renal artery stenosis (RAS) may be a relevant and treatable cause of hypertension. OBJECTIVE: To investigate the prevalence of RAS in patients with APS and hypertension. PATIENTS AND METHODS: Three groups of patients were evaluated (1) 77 patients with positive antiphospholipid antibodies (aPL) (60 secondary APS, 11 primary APS, and 6 with aPL only) and uncontrolled hypertension who were receiving two or more antihypertensive drugs; (2) 91 patients (hypertension clinics;(3) 92 normotensive healthy, potential renal transplant donors. Magnetic resonance renal angiography was used to image the renal arteries in all three groups. RESULTS: Group 1 20/77 (26%) patients had evidence of RAS (16 unilateral and 4 bilateral). Sixteen patients (80%) had smooth well defined stenoses in the proximal third of the renal artery. Three further patients had irregular arteries without distinct stenosis. Group 2 7/91 (8%) hypertensive patients had RAS (chi(2)=10.3, p<0.001 v group 1). Group 3 3/92 (3%) healthy donors had RAS (chi(2)=18.2, p<0.0001 v group 1). CONCLUSION: A significantly increased prevalence of RAS (26%) was found in patients with APS and hypertension, compared with relatively young (donors.