Background: Atherosclerotic renovascular disease has been increasingly recognised as a common cause of end-stage renal failure in elderly people. The optimum management of this condition is unclear. The aim of this study was the prospective evaluation of the long-term renal outcome in kidneys with atherosclerotic nephropathy.

Methods: We have performed sequential individual GFR (glomerular filtration rate) measurements in 115 kidneys where it or its contralateral kidney had angiographically proven atherosclerotic renal artery stenosis over a mean period of 19.37 ± 15.1 months (range 2–66 months). The individual renal function was measured by a synchronous combination of 51chromium ethylene-diamine-tetra-acetic acid GFR (51CrEDTA GFR) and technetium dimercaptosuccinic acid (99mTc DMSA) scintigraphy, the so-called single kidney (SK) GFR test. According to the angiography findings, individual kidneys were divided into four groups: normal, stenosis, occlusion and those treated with balloon angioplasty with or without stent employment.

Results: We have calculated the annualised rate of SKGFR change in the four groups of kidney (2.89 ± 8.93 ml/min/year in the normal group, -0.19 ± 4.99 ml/min/year in the stenosis group, 0.66 ± 3.21 ml/min/year in the occlusion group and -1.81±14 ml/min/year in the group of kidneys undergoing percutaneous revascularisation) and no statistically significant difference was found (p > 0.05). For paired kidneys with at least one undergoing balloon angioplasty, the percentage of change between the SKGFR measured before and after revascularisation did not differ between the kidneys revascularised and the contralateral ones (p > 0.05).

Conclusions: Our data showed no significant difference in long-term renal outcome in kidneys with and without renal artery narrowing and in the ones undergoing percutaneous revascularisation. The data also show a relatively slow decline in function in kidneys with untreated renal artery stenosis when followed in a specialist clinic. This suggests that other pathological mechanisms as well as renal artery narrowing can injure the renal parenchyma in atherosclerotic renal artery stenosis.