Morphology of coronary atherosclerotic lesions in patients with end-stage renal failure

被引:501
作者
Schwarz, U
Buzello, M
Ritz, E
Stein, G
Raabe, G
Wiest, G
Mall, G
Amann, K
机构
[1] Heidelberg Univ, Dept Internal Med, D-6900 Heidelberg, Germany
[2] Dept Internal Med, Jena, Germany
[3] Heidelberg Univ, Dept Pathol, D-6900 Heidelberg, Germany
[4] Dept Pathol, Darmstadt, Germany
[5] Dept Pathol, Jena, Germany
关键词
atherosclerosis; uraemia; coronary artery disease; plaque structure; calcification;
D O I
10.1093/ndt/15.2.218
中图分类号
R3 [基础医学]; R4 [临床医学];
学科分类号
1001 ; 1002 ; 100602 ;
摘要
Background. An excessive rate of cardiac death is a well-known feature of renal failure. Coronary heart disease is frequent and the possibility has been raised that the natural history of the coronary plaque is different in uraemic patients. We assessed the morphology of coronary arteries in patients with end-stage renal failure and compared them with coronary arteries of matched non-uraemic control patients. Methods. Fifty-four cases were identified at autopsy who met the inclusion criteria: cases, end-stage renal disease (n=27); controls, non-renal patients with coronary artery disease (n=27). At autopsy all three coronary arteries were prepared at corresponding sites for investigations: (i) qualitative analysis (after Stary), (ii) quantitative measurements of intima and media thickness (by planimetry), (iii) immunohistochemical analysis of the coronary plaques and (iv) X-ray diffraction of selected calcified plaques. Results. Qualitative analysis of the coronary arteries showed significantly more calcified plaques of coronary arteries in patients with end-stage renal failure. Plaques of non-uraemic patients were mostly fibroatheromatous. Media thickness of coronary arteries was significantly higher in uraemic patients (187+/-53 mu m vs 135+/-29 mu m in controls) and intima thickness tended to be higher (158+/-38 mu m vs 142+/-31 mu m) but this difference was not statistically significant. Plaque area (4.09+/-1.50 mm(2) vs 4.39+/-0.88 mm(2)) was comparable in both groups. Lumen area, however, was significantly lower in end-stage renal patients. Immunohistochemical analysis of the cellular infiltrate in coronary arteries showed no major differences in these advanced plaques of uraemic and non-uraemic subjects. Conclusion. Coronary plaques in patients with endstage renal failure are characterized by increased media thickness and marked calcification. In contrast to the previous opinion the most marked difference compared to non-uraemic controls does not concern the size, but the composition of the plaque. Deposition of calcium within the plaques may contribute to the high complication rate in uraemic patients.
引用
收藏
页码:218 / 223
页数:6
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