Incidence of donor renal fibromuscular dysplasia: Does it justify routine angiography?

Kenneth A. Andreoni, Susan M. Weeks, David A. Gerber, Jeffrey Fair, Matthew A. Mauro, Lynn McCoy, Lisa Scott, Mark W. Johnson

Research output: Contribution to journalArticle

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Abstract

Background. The use of digital subtraction angiography (DSA) versus helical CT angiography (CTA) or MR angiography (MRA) for live renal donor evaluation is still controversial. Although CTA and MRA can detect some proximal moderate to severe arterial changes caused by fibromuscular dysplasia (FMD), mild and distal moderate FMD are not detected well without angiography. Methods. This is a retrospective chart review of all potential, normotensive live renal donors at our center from July 1995 to June 2001. One hundred fiftynine patients completed the donor evaluation process and underwent DSA. Results. Seven cases of FMD, an incidence of 4.4%, were discovered. These patients were eliminated from donation. The distribution of renal vessels for our 159 patients was single arteries bilaterally, 64.8%; single left with multiple right, 16.4%; double left with single right, 9.4%; and multiple bilateral arteries, 9.4%. Three of the seven FMD patients had bilateral disease. Two of the seven (28.6%) FMD patients have subsequently required antihypertensive medications, with one requiring angioplasty of a progressive FMD stenotic lesion. Conclusions. We are concerned that CTA or MRA may overlook mild cases of DSA-detectable FMD. All seven FMD patients had single left renal arteries and would have undergone left donor nephrectomy. This would have resulted in their remaining right native kidneys having mild to moderate FMD in six of seven patients and in four donor kidneys having mild to moderate FMD. The need for antihypertensive medications in two of these seven potential donors within 4 years of their evaluation supports previous literature reports.

Original languageEnglish (US)
Pages (from-to)1112-1116
Number of pages5
JournalTransplantation
Volume73
Issue number7
StatePublished - Apr 15 2002
Externally publishedYes

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Fibromuscular Dysplasia
Angiography
Tissue Donors
Kidney
Incidence
Digital Subtraction Angiography
Antihypertensive Agents
Arteries
Spiral Computed Tomography
Renal Artery
Nephrectomy
Angioplasty

ASJC Scopus subject areas

  • Transplantation
  • Immunology

Cite this

Andreoni, K. A., Weeks, S. M., Gerber, D. A., Fair, J., Mauro, M. A., McCoy, L., ... Johnson, M. W. (2002). Incidence of donor renal fibromuscular dysplasia: Does it justify routine angiography? Transplantation, 73(7), 1112-1116.

Incidence of donor renal fibromuscular dysplasia : Does it justify routine angiography? / Andreoni, Kenneth A.; Weeks, Susan M.; Gerber, David A.; Fair, Jeffrey; Mauro, Matthew A.; McCoy, Lynn; Scott, Lisa; Johnson, Mark W.

In: Transplantation, Vol. 73, No. 7, 15.04.2002, p. 1112-1116.

Research output: Contribution to journalArticle

Andreoni, KA, Weeks, SM, Gerber, DA, Fair, J, Mauro, MA, McCoy, L, Scott, L & Johnson, MW 2002, 'Incidence of donor renal fibromuscular dysplasia: Does it justify routine angiography?', Transplantation, vol. 73, no. 7, pp. 1112-1116.
Andreoni KA, Weeks SM, Gerber DA, Fair J, Mauro MA, McCoy L et al. Incidence of donor renal fibromuscular dysplasia: Does it justify routine angiography? Transplantation. 2002 Apr 15;73(7):1112-1116.
Andreoni, Kenneth A. ; Weeks, Susan M. ; Gerber, David A. ; Fair, Jeffrey ; Mauro, Matthew A. ; McCoy, Lynn ; Scott, Lisa ; Johnson, Mark W. / Incidence of donor renal fibromuscular dysplasia : Does it justify routine angiography?. In: Transplantation. 2002 ; Vol. 73, No. 7. pp. 1112-1116.
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abstract = "Background. The use of digital subtraction angiography (DSA) versus helical CT angiography (CTA) or MR angiography (MRA) for live renal donor evaluation is still controversial. Although CTA and MRA can detect some proximal moderate to severe arterial changes caused by fibromuscular dysplasia (FMD), mild and distal moderate FMD are not detected well without angiography. Methods. This is a retrospective chart review of all potential, normotensive live renal donors at our center from July 1995 to June 2001. One hundred fiftynine patients completed the donor evaluation process and underwent DSA. Results. Seven cases of FMD, an incidence of 4.4{\%}, were discovered. These patients were eliminated from donation. The distribution of renal vessels for our 159 patients was single arteries bilaterally, 64.8{\%}; single left with multiple right, 16.4{\%}; double left with single right, 9.4{\%}; and multiple bilateral arteries, 9.4{\%}. Three of the seven FMD patients had bilateral disease. Two of the seven (28.6{\%}) FMD patients have subsequently required antihypertensive medications, with one requiring angioplasty of a progressive FMD stenotic lesion. Conclusions. We are concerned that CTA or MRA may overlook mild cases of DSA-detectable FMD. All seven FMD patients had single left renal arteries and would have undergone left donor nephrectomy. This would have resulted in their remaining right native kidneys having mild to moderate FMD in six of seven patients and in four donor kidneys having mild to moderate FMD. The need for antihypertensive medications in two of these seven potential donors within 4 years of their evaluation supports previous literature reports.",
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T2 - Does it justify routine angiography?

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AU - Weeks, Susan M.

AU - Gerber, David A.

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AU - Mauro, Matthew A.

AU - McCoy, Lynn

AU - Scott, Lisa

AU - Johnson, Mark W.

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N2 - Background. The use of digital subtraction angiography (DSA) versus helical CT angiography (CTA) or MR angiography (MRA) for live renal donor evaluation is still controversial. Although CTA and MRA can detect some proximal moderate to severe arterial changes caused by fibromuscular dysplasia (FMD), mild and distal moderate FMD are not detected well without angiography. Methods. This is a retrospective chart review of all potential, normotensive live renal donors at our center from July 1995 to June 2001. One hundred fiftynine patients completed the donor evaluation process and underwent DSA. Results. Seven cases of FMD, an incidence of 4.4%, were discovered. These patients were eliminated from donation. The distribution of renal vessels for our 159 patients was single arteries bilaterally, 64.8%; single left with multiple right, 16.4%; double left with single right, 9.4%; and multiple bilateral arteries, 9.4%. Three of the seven FMD patients had bilateral disease. Two of the seven (28.6%) FMD patients have subsequently required antihypertensive medications, with one requiring angioplasty of a progressive FMD stenotic lesion. Conclusions. We are concerned that CTA or MRA may overlook mild cases of DSA-detectable FMD. All seven FMD patients had single left renal arteries and would have undergone left donor nephrectomy. This would have resulted in their remaining right native kidneys having mild to moderate FMD in six of seven patients and in four donor kidneys having mild to moderate FMD. The need for antihypertensive medications in two of these seven potential donors within 4 years of their evaluation supports previous literature reports.

AB - Background. The use of digital subtraction angiography (DSA) versus helical CT angiography (CTA) or MR angiography (MRA) for live renal donor evaluation is still controversial. Although CTA and MRA can detect some proximal moderate to severe arterial changes caused by fibromuscular dysplasia (FMD), mild and distal moderate FMD are not detected well without angiography. Methods. This is a retrospective chart review of all potential, normotensive live renal donors at our center from July 1995 to June 2001. One hundred fiftynine patients completed the donor evaluation process and underwent DSA. Results. Seven cases of FMD, an incidence of 4.4%, were discovered. These patients were eliminated from donation. The distribution of renal vessels for our 159 patients was single arteries bilaterally, 64.8%; single left with multiple right, 16.4%; double left with single right, 9.4%; and multiple bilateral arteries, 9.4%. Three of the seven FMD patients had bilateral disease. Two of the seven (28.6%) FMD patients have subsequently required antihypertensive medications, with one requiring angioplasty of a progressive FMD stenotic lesion. Conclusions. We are concerned that CTA or MRA may overlook mild cases of DSA-detectable FMD. All seven FMD patients had single left renal arteries and would have undergone left donor nephrectomy. This would have resulted in their remaining right native kidneys having mild to moderate FMD in six of seven patients and in four donor kidneys having mild to moderate FMD. The need for antihypertensive medications in two of these seven potential donors within 4 years of their evaluation supports previous literature reports.

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