Yavuz AYAR, Barış DÖNER, Suat AKGÜR, Mustafa İŞLEYEN, Gökhan OCAKOĞLU

Renal artery stenosis: a single center experience

Objectives: Renal artery stenosis (RAS) is among the most common causes of secondary hypertension. Prevalence of RAS are seen in end-stage renal disease (ESRD) patients with hypertension between 1-10%. In our study, we evaluated the data of patients with RAS who were followed up with medical treatment and stenting. Methods: In our study, patients who were thought to have renal artery stenosis (RAS) with renal artery doppler ultrasonography were scanned with contrast-enhanced Magnetic Resonance Angiography (MRA). Fifty-three patients (10 received medical therapy, 43 applied invasive procedure) who diagnosed with RAS evaluated. Results: Follow-up times were 15 (12-84) months in patients who received medical therapy, and 12 (10-96) months in patients who treated with invasive therapy (p = 0.583). Median ages were 56 (19-74) years in medical treatment group, and 60 (15-77) years in invasive therapy group (p = 0.955). Compared with the beginning of treatment, diastolic hypertension was decreased of 12.5% in invasive treatment group opposite medical therapy group (p = 0.040), so eGFR was increased of 5.94% in invasive treatment group. Conclusions: In recent years, several studies about survival in patients with RAS was observed that there was no significant difference between the medical and invasive treatment. Clinical, laboratory, and individual characteristics should be considered in treatment choice.

Keywords:

Chronic renal failure, hypertension, renal artery stenosis.,

PDF

___

1. Bavishi C, de Leeuw PW, Messerli FH. Atherosclerotic renal artery stenosis and hypertension: pragmatism, pitfalls, and perspectives. Am J Med 2016;129:635.e5-14.
2. Safian RD, Textor SC. Renal-artery stenosis. N Engl J Med 2001;344:431-42.
3. Hansen KJ, Edwards MS, Craven TE, Cherr GS, Jackson SA, Appel RG, et al. Prevalence of renovascular disease in the elderly: a population-based study. J Vasc Surg 2002;36:443-51.
4. Textor SC. Managing renal arterial disease and hypertension. Curr Opin Cardiol 2003;18:260-7.
5. van Jaarsveld BC, Krijnen P, Pieterman H, Derkx FMH, Deinum J, Postma CT, et al. The effect of balloon angioplasty on hypertension in atherosclerotic renal-artery stenosis. N Engl J Med 2000;342:1007-14.
6. Haller C. Arteriosclerotic renal artery stenosis: conservative versus interventional management. Heart 2002;88:193-7.
7. Cooper CJ, Murphy TP, Cutlip DE, Jamerson K, Henrich W, Reid DM, et al. CORAL Investigators. Stenting and medical therapy for atherosclerotic renal-artery stenosis. N Engl J Med 2014;370:13-22.
8. KDIGO 2012 clinical practice guideline for the evaluation and management of chronic kidney disease. Kidney Int Suppl 2013;3:1-150.
9. Herrmann SM, Textor SC. Current concepts in the treatment of renovascular hypertension. Am J Hypertens 2018;31:139-49.
10. Tafur JD, White CJ. Renal artery stenosis: when to revascularize in 2017. Curr Probl Cardiol 2017;42:110-35.
11. Hansen KJ, Edwards MS, Craven TE, Cherr GS, Jackson SA, Appel RG, et al. Prevalence of renovascular disease in the elderly: a population-based study. J Vasc Surg 2002;36:443-51.
12. Textor SC. Renal arterial disease and hypertension. Med Clin North Am 2017;101:65-79.
13. de Mast Q, Beutler JJ. The prevalence of atherosclerotic renal artery stenosis in risk groups: a systematic literature review. J Hypertens 2009;27:1333-40.
14. Klein AJ, Jaff MR, Gray BH, Aronow HD, Bersin RM, Diaz-Sandoval LJ, et al. SCAI appropriate use criteria for peripheral arterial interventions: an update. Catheter Cardiovasc Interv 2017;90:E90-E110.
15. Gottsäter A, Lindblad B. Optimal management of renal artery fibromuscular dysplasia. Ther Clin Risk Manag 2014;10:583-95.
16. Conlon PJ, Little MA, Pieper K, Mark DB. Severity of renal vascular disease predicts mortality in patients undergoing coronary angiography. Kidney Int 2001;60:1490-7.
17. Wright JR, Duggal A, Thomas R, Reeve R, Roberts IS, Kalra PA. Clinicopathological correlation in biopsy-proven atherosclerotic nephropathy: implications for renal functional outcome in atherosclerotic renovascular disease. Nephrol Dial Transplant 2001;16:765-70.
18. Watson PS, Hadjipetrou P, Cox SV, Piemonte TC, Eisenhauer AC. Effect of renal artery stenting on renal function and size in patients with atherosclerotic renovascular disease. Circulation 2000;102:1671-7.
19. Dejani H, Eisen TD, Finkelstein FO. Revascularization of renal artery stenosis in patients with renal insufficiency. Am J Kidney Dis 2000;36:752-8.
20. Marone LK, Clouse WD, Dorer DJ, Brewster DC, Lamuraglia GM, Watkins MT, et al. Preservation of renal function with surgical revascularization in patients with atherosclerotic renovascular disease. J Vasc Surg 2004;39:322-9.
21. Morganti A, Bencini C, Del Vecchio C, Strata M. Treatment of atherosclerotic renal artery stenosis. J Am Soc Nephrol 2002;13 Suppl 3:S187-9.
22. Bax L, Mali WP, Buskens E, Koomans HA, Beutler JJ, Braam B, et al. STAR Study Group. J Nephrol 2003;16:807-12.
23. Wheatley K, Ives N, Gray R, Kalra PG, Moss JG, Baigent C, et al. The ASTRAL Investigators. Revascularization versus medical therapy for renal-artery stenosis. N Engl J Med 2009;361:1953-62.
24. Meng X, Zhou Y, Jiang XJ, Jun Cai, Zhang HM, Wu HY, et al. Etiology spectrum and clinical characteristics of renal artery stenosis in a Chinese cohort. J Geriatr Cardiol 2021;18:104-13.