Ischemic nephropathy: an important cause of renal disease in the elderly.

RAOD is an important cause of progressive renal failure in the elderly population. We can expect to see an increasing incidence of this disease as the population ages. A non-invasive test for detecting this condition with a high degree of sensitivity and specificity has been developed, although the technique is sufficiently difficult that it is currently available in only a few specialized centers. Indications for intervention to preserve renal function are not clear. Application of stenting to renal artery lesions has lead some to advocate treatment of these lesions empirically when they are detected much as is done with coronary artery lesions in patients with ischemic heart disease. Given the present state of knowledge, this is not an unreasonable approach. However, not all lesions progress and their role in causing renal failure is not clear in all cases. Furthermore, intervention can cause worsening of renal failure in some cases and actually precipitate the need for dialysis. Several recommendations are reasonable based on this review. Patients over 50 starting dialysis with renal failure of unknown etiology should be screened for RAOD. Those with bilateral lesions should be offered an intervention. Patients with mild or moderate renal failure of unknown etiology over age 50 should also be screened. Those with bilateral lesions should be offered an intervention with conservative management for those with unilateral lesions. The later group should be monitored on a yearly basis for the development of contralateral lesions or significant bilateral renal atrophy. If either of these eventualities develop, intervention should be offered. These recommendations would have to be considered in the light of the possible need to perform an intervention for the treatment of hypertension.