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Dregoesc MI, Bolboacă SD, Dorolțan PM, Istrate M, Marc MC, Iancu AC. Long-Term Mortality After Renal Artery Stenting in Patients With Severe Atherosclerotic Renal Artery Stenosis and High-Risk Clinical Manifestations. Am J Hypertens 2021; 34:880-887. [PMID: 33530094 DOI: 10.1093/ajh/hpab027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Revised: 10/19/2020] [Accepted: 01/27/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Atherosclerotic renal artery stenosis is a risk factor for cardiovascular death. Observational studies support the benefit of renal revascularization on outcomes in patients with high-risk clinical manifestations. In this context, we evaluated the factors associated with long-term mortality after renal artery stenting in patients with severe renal artery stenosis, impaired kidney function, and/or uncontrolled hypertension. METHODS The medical records of patients undergoing renal artery stenting between 2004 and 2014 were extracted. Blood pressure and creatinine were recorded at baseline, 24 hours poststenting and in the 1-month to 1-year interval that followed revascularization. Long-term follow-up was performed in March 2020. RESULTS The cohort consisted of 65 patients. Median follow-up was 120 months. In the first year after stenting, less patients had chronic kidney disease (CKD) class 3b-5 as compared with baseline (35.3% vs. 56.9%, P = 0.01). The number of patients with controlled blood pressure after revascularization increased with 69.2% (P < 0.001). Long-term all-cause mortality reached 44.6%. Age (odds ratio (OR) 1.1; 95% confidence interval (CI) 1.0-1.2; P = 0.01), male gender (OR 7.9; 95% CI 1.9-43.5; P = 0.008), poststenting CKD class 3b-5 (OR 5.8; 95% CI 1.5-27.9; P = 0.01), and postrevascularization uncontrolled hypertension (OR 8.9; 95% CI 1.7-63.5; P = 0.01) were associated with long-term mortality independent of diabetes mellitus and coronary artery disease. CONCLUSIONS Improved CKD class and blood pressure were recorded in the first year after renal artery stenting in patients with severe renal artery stenosis and high-risk clinical manifestations. The lack of improvement in kidney function and blood pressure was independently associated with long-term mortality.
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Affiliation(s)
- Mihaela Ioana Dregoesc
- “Iuliu Hațieganu” University of Medicine and Pharmacy, Department of Cardiology, Cluj-Napoca, Romania
| | - Sorana Daniela Bolboacă
- “Iuliu Hațieganu” University of Medicine and Pharmacy, Department of Medical Informatics and Biostatistics, Cluj-Napoca, Romania
| | - Patricia Mirela Dorolțan
- “Iuliu Hațieganu” University of Medicine and Pharmacy, Department of Cardiology, Cluj-Napoca, Romania
| | - Mihnea Istrate
- “Iuliu Hațieganu” University of Medicine and Pharmacy, Department of Cardiology, Cluj-Napoca, Romania
| | | | - Adrian Corneliu Iancu
- “Iuliu Hațieganu” University of Medicine and Pharmacy, Department of Cardiology, Cluj-Napoca, Romania
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Çınar T, Rencüzoğulları I, Karabağ Y, Çağdaş M. Renal arterial atherothrombosis due to catheter-induced dissection: Necessity of urgent intervention in a patient with a solitary functioning kidney. Heart Lung 2018; 48:69-71. [PMID: 30121120 DOI: 10.1016/j.hrtlng.2018.07.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2018] [Revised: 07/17/2018] [Accepted: 07/24/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Renal artery stenosis (RAS) is a leading cause of hypertension, renal failure, pulmonary edema, and loss of renal mass. Atherothrombotic renal disease is a well-described entity, known primarily for its high mortality rate. CASE Here, we present a case of acute unrecognized atherothrombosis of RAS due to catheter-induced dissection in a patient with a limited functioning renal artery and solitary kidney. A fifty-two-year-old patient recently diagnosed with hypertension was admitted to our cardiology clinic showing symptoms of uncontrolled hypertension. A renal angiography revealed 90% stenosis in the proximal segment of the right renal artery and totally occluded left renal artery. We decided to perform a percutaneous revascularization. However, the patient did not accept it. During follow-up, the patient's clinical condition deteriorated abruptly due to acute iatrogenic atherothrombosis. A percutaneous transluminal angioplasty was performed, and the patency of the renal artery was secured. CONCLUSION Renal angiography may cause acute iatrogenic atherothrombosis due to catheter-induced dissection in patients with solitary functioning kidneys. Percutaneous transluminal angioplasty may secure the patency of the renal artery.
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Affiliation(s)
- Tufan Çınar
- Sultan Abdülhamid Han Training and Research Hospital, Health Sciences University, Tibbiye Street, Uskudar, Istanbul, Turkey.
| | | | - Yavuz Karabağ
- Department of Cardiology, Kafkas University Medical School, Kars, Turkey
| | - Metin Çağdaş
- Department of Cardiology, Kafkas University Medical School, Kars, Turkey
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Ma Z, Liu L, Zhang B, Chen W, Yang J, Li H. Renal artery stent in solitary functioning kidneys: 77% of benefit: A systematic review with meta-analysis. Medicine (Baltimore) 2016; 95:e4780. [PMID: 27603380 PMCID: PMC5023903 DOI: 10.1097/md.0000000000004780] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Solitary functioning kidney (SFK) is tough issue to address in clinical, mostly developed from renal artery stenosis (RAS) in adults. Although renal artery stent is widely used to help SFK patients, the efficacy of the stent is still disputable. This study is aimed at reviewing a series of SFK cases to draw a conclusion about the efficacy of renal artery stent. METHODS All related papers published in PubMed, Web of Science, EMBASE, and Cochrane Library were searched. Studies or subsets were included only if they satisfied certain criteria. The benefit rate which equaled the rate of improvement subjoining the rate of stabilization was calculated. All analyses were conducted with Stata version 12.0 (Stata Corporation, College Station, TX). RESULTS According to 7 papers on the efficacy of renal artery stent, 253 SFK patients were included. The result revealed that the renal artery stent could help SFK patients to improve or stabilize their renal function (RF). The benefit rate was 0.77, with 95% confidence interval between 0.72 and 0.83. CONCLUSIONS With proper patient selection, renal artery stent could benefit SFK patients with a percentage odd of 0.77 to improve or stabilize the RF.
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Affiliation(s)
- Zhenjiang Ma
- Department of Interventional Radiology, the First Affiliated Hospital of Sun Yat-sen University, the First Affiliated Hospital of Sun Yat-sen University
| | - Liangshuai Liu
- Department of Radiology, the Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital)
| | - Bing Zhang
- Department of Nuclear Medicine, the First Affiliated Hospital of Sun Yat-sen University
| | - Wei Chen
- Department of Interventional Radiology, the First Affiliated Hospital of Sun Yat-sen University, the First Affiliated Hospital of Sun Yat-sen University
| | - Jianyong Yang
- Department of Radiology, the First Affiliated Hospital of Sun Yat-sen University
| | - Heping Li
- Department of Medical Oncology, the First Affiliated Hospital of Sun Yat-sen University, China
- Correspondence: Heping Li, Department of Medical Oncology, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, P.R. China (e-mail: )
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Misra S, Khosla A, Allred J, Harmsen WS, Textor SC, McKusick MA. Mortality and Renal Replacement Therapy after Renal Artery Stent Placement for Atherosclerotic Renovascular Disease. J Vasc Interv Radiol 2016; 27:1215-24. [PMID: 27296703 DOI: 10.1016/j.jvir.2016.05.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Revised: 04/29/2016] [Accepted: 05/01/2016] [Indexed: 11/15/2022] Open
Abstract
PURPOSE To identify risk factors for progression to renal replacement therapy (RRT) and all-cause mortality in patients who underwent renal artery (RA) stent placement for atherosclerotic renal artery stenosis (RAS). MATERIALS AND METHODS A retrospective study from June 1996 to June 2009 identified 1,052 patients who underwent RA stent placement. Glomerular filtration rate at time of RA stent placement was estimated from serum creatinine level and divided into chronic kidney disease (CKD) stages 1-5. Univariate and multivariable Cox proportional hazards models were used to determine which factors were associated with each endpoint. RESULTS Times to progression to all-cause mortality and RRT were similar for CKD stages 1/2/3A and served as the reference group. In multivariable analysis, high-grade proteinuria (P < .001) and higher CKD stage (5 vs 1/2/3A [P < .001], 4 vs 1/2/3A [P < .001], 3B vs 1/2/3A [P = .02]) remained independently associated with increased risk of progression to RRT. Angiotensin-converting enzyme inhibitor/angiotensin receptor blocker (ACEI/ARB) use was associated with decreased risk of progression to RRT (P = .03). Higher CKD stage (5 vs 1/2/3A [P < .001], 4 vs 1/2/3A [P = .004]), carotid artery disease (P < .001), diabetes mellitus (P = .002), and high-grade proteinuria (P < .001) remained independently associated with all-cause mortality. Statin use was associated with decreased risk of all-cause mortality (P < .001). CONCLUSIONS Patients with atherosclerotic RAS who undergo RA stent placement and have high-grade proteinuria and CKD stage 3B/4/5 have increased risk of progression to RRT. Patients with high-grade proteinuria, CKD stage 3B/4/5, carotid artery disease, or diabetes have increased risk for all-cause mortality after renal artery stent placement. Patients receiving ACEI/ARBs have a decreased risk of progression to RRT, and patients receiving statins have a decreased risk of all-cause mortality.
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Affiliation(s)
- Sanjay Misra
- Vascular and Interventional Radiology Translational Laboratory, Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905.
| | - Ankaj Khosla
- Vascular and Interventional Radiology Translational Laboratory, Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905
| | - Jake Allred
- Vascular and Interventional Radiology Translational Laboratory, Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905
| | - William S Harmsen
- Vascular and Interventional Radiology Translational Laboratory, Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905
| | - Stephen C Textor
- Division of Nephrology and Hypertension, Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905
| | - Michael A McKusick
- Division of Vascular and Interventional Radiology, Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905
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Sawai T, Miyahara M, Okamoto R, Dohi K, Tanigawa T, Yamada N, Nakamura M, Ito M. Marked improvement of renal failure and severe hypertension after renal artery stenting in the solitary functioning kidney. J Cardiol Cases 2013; 7:e82-e85. [PMID: 30533129 DOI: 10.1016/j.jccase.2012.12.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2012] [Revised: 11/04/2012] [Accepted: 12/04/2012] [Indexed: 12/01/2022] Open
Abstract
Atherosclerotic renal artery stenosis (ARAS) can cause resistant hypertension, progressive renal failure and/or cardiorenal syndrome. Although no randomized study to demonstrate the superiority of renal stenting over medical treatment is available, a case-sensitive approach is required for the treatment of ARAS. Here, we describe a case report of a symptomatic ARAS patient with a solitary functioning kidney in which successful detection of ARAS by ultrasonography examination with the Doppler method and timely renal artery stenting were performed. <Learning objective: The clinical efficacy of renal artery stenting for symptomatic ARAS as a method of lowering blood pressure and preventing deterioration in renal function remains unproven. However, renal artery stenting performed based on enough investigation of clinical course and information by ultrasonography examination with Doppler method results in benefit to the patient with ARAS.>.
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Affiliation(s)
- Toshiki Sawai
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie 514-8507, Japan
| | - Masatoshi Miyahara
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie 514-8507, Japan
| | - Ryuji Okamoto
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie 514-8507, Japan
| | - Kaoru Dohi
- Department of Molecular and Laboratory Medicine, Mie University Graduate School of Medicine, Tsu, Japan
| | - Takashi Tanigawa
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie 514-8507, Japan
| | - Norikazu Yamada
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie 514-8507, Japan
| | - Mashio Nakamura
- Department of Clinical Cardiovascular Research, Mie University Graduate School of Medicine, Tsu, Japan
| | - Masaaki Ito
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie 514-8507, Japan
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Evaluation of Renal Artery in Hypertensive Patients by Unenhanced MR Angiography Using Spatial Labeling With Multiple Inversion Pulses Sequence and by CT Angiography. AJR Am J Roentgenol 2012; 199:1142-8. [PMID: 23096191 DOI: 10.2214/ajr.11.7263] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Abstract
Renal artery intervention to treat hypertension is one of the frontiers of ongoing research in combating this epidemic. This article focuses on recent data regarding PTRS and catheter-based renal sympathetic denervation. Despite progress in this field large multicenter, randomized trials that compare these treatment modalities with medical therapy for hypertension are lacking.
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Affiliation(s)
- Rajan A G Patel
- Department of Cardiology, Ochsner Clinic Foundation, New Orleans, LA 70121, USA
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Vykoukal D, Davies MG. Metabolic syndrome and outcomes after renal intervention. Cardiol Res Pract 2010; 2011:781035. [PMID: 21234418 PMCID: PMC3014711 DOI: 10.4061/2011/781035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2010] [Revised: 11/27/2010] [Accepted: 12/10/2010] [Indexed: 11/20/2022] Open
Abstract
Metabolic syndrome significantly increases the risk for cardiovascular disease and chronic kidney disease. The increased risk for cardiovascular diseases can partly be caused by a prothrombotic state that exists because of abdominal obesity. Multiple observational studies have consistently shown that increased body mass index as well as insulin resistance and increased fasting insulin levels is associated with chronic kidney disease, even after adjustment for related disorders. Metabolic syndrome appears to be a risk factor for chronic kidney disease, likely due to the combination of dysglycemia and high blood pressure. Metabolic syndrome is associated with markedly reduced renal clinical benefit and increased progression to hemodialysis following endovascular intervention for atherosclerotic renal artery stenosis. Metabolic syndrome is associated with inferior early outcomes for dialysis access procedures.
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Affiliation(s)
- Daynene Vykoukal
- Department of Cardiovascular Surgery, Methodist DeBakey Heart and Vascular Center, The Methodist Hospital, 6550 Fannin, Smith Tower, Suite 1401, Houston, TX 77030, USA
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Boccuzzi GG, Di Maggio L, Massara C, Garbo R, Savio D. Intravascular ultrasound-guided rotational atherectomy for heavily calcified renal artery stenosis. J Cardiovasc Med (Hagerstown) 2010; 13:338-42. [PMID: 20186070 DOI: 10.2459/jcm.0b013e328334341a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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