1
|
Sarafidis PA, Theodorakopoulou M, Ortiz A, Fernandez-Fernández B, Nistor I, Schmieder R, Arici M, Saratzis A, Van der Niepen P, Halimi JM, Kreutz R, Januszewicz A, Persu A, Cozzolino M. Atherosclerotic renovascular disease: a clinical practice document by the European Renal Best Practice (ERBP) board of the European Renal Association (ERA) and the Working Group Hypertension and the Kidney of the European Society of Hypertension (ESH). Nephrol Dial Transplant 2023; 38:2835-2850. [PMID: 37202218 PMCID: PMC10689166 DOI: 10.1093/ndt/gfad095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Indexed: 05/20/2023] Open
Abstract
Atherosclerotic renovascular disease (ARVD) is the most common type of renal artery stenosis. It represents a common health problem with clinical presentations relevant to many medical specialties and carries a high risk for future cardiovascular and renal events, as well as overall mortality. The available evidence regarding the management of ARVD is conflicting. Randomized controlled trials failed to demonstrate superiority of percutaneous transluminal renal artery angioplasty (PTRA) with or without stenting in addition to standard medical therapy compared with medical therapy alone in lowering blood pressure levels or preventing adverse renal and cardiovascular outcomes in patients with ARVD, but they carried several limitations and met important criticism. Observational studies showed that PTRA is associated with future cardiorenal benefits in patients presenting with high-risk ARVD phenotypes (i.e. flash pulmonary oedema, resistant hypertension or rapid loss of kidney function). This clinical practice document, prepared by experts from the European Renal Best Practice (ERBP) board of the European Renal Association (ERA) and from the Working Group on Hypertension and the Kidney of the European Society of Hypertension (ESH), summarizes current knowledge in epidemiology, pathophysiology and diagnostic assessment of ARVD and presents, following a systematic literature review, key evidence relevant to treatment, with an aim to support clinicians in decision making and everyday management of patients with this condition.
Collapse
Affiliation(s)
- Pantelis A Sarafidis
- Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Marieta Theodorakopoulou
- Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Alberto Ortiz
- Department of Nephrology and Hypertension, IIS-Fundacion Jimenez Diaz UAM, Madrid, Spain
| | | | - Ionut Nistor
- Department of Internal Medicine, Nephrology and Geriatrics, Grigore T Popa University of Medicine and Pharmacy, Iasi, Romania
- Department of Nephrology, Dr C I Parhon University Hospital, Iasi, Romania
| | - Roland Schmieder
- Department of Nephrology and Hypertension, University Hospital Erlangen, Erlangen, Germany
| | - Mustafa Arici
- Department of Nephrology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Athanasios Saratzis
- Department of Cardiovascular Sciences & Leicester Vascular Institute, University Hospital Leicester, Leicester, UK
| | - Patricia Van der Niepen
- Department of Nephrology & Hypertension, Universitair ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Jean-Michel Halimi
- Service de Néphrologie-Hypertension, Dialyses, Transplantation rénale, CHRU Tours, Tours, France and INSERM SPHERE U1246, Université Tours, Université de Nantes, Tours, France
| | - Reinhold Kreutz
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institut für Klinische Pharmakologie und Toxikologie, Berlin, Germany
| | - Andrzej Januszewicz
- Department of Hypertension, National Institute of Cardiology, Warsaw, Poland
| | - Alexandre Persu
- Division of Cardiology, Cliniques Universitaires Saint-Luc and Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium
| | - Mario Cozzolino
- Renal Division, ASST Santi Paolo e Carlo, Department of Health Sciences, University of Milan, Milan, Italy
| |
Collapse
|
2
|
Seydoux C, Hemett OM, Périard D, Descombes E. Severe acute kidney injury in a patient with renal artery stenosis of a single-functioning kidney: A case report of rapid normalisation of the renal function after percutaneous transluminal angioplasty with stent placement. SAGE Open Med Case Rep 2023; 11:2050313X231209639. [PMID: 37941982 PMCID: PMC10629318 DOI: 10.1177/2050313x231209639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 10/06/2023] [Indexed: 11/10/2023] Open
Abstract
Revascularisation of renal arterial stenosis in acute settings, such as uncontrolled arterial hypertension, flash pulmonary oedema and/or acute renal failure, has shown controversial results in observational and prospective studies. Current guidelines do not recommend revascularisation in the occurrence of renal failure as revascularisation and best medical treatment have shown similar long-term outcomes on renal function. We describe a case of acute degradation of the renal function (with oligo-anuria and a peak creatinine of 462 µmol/L) after the re-introduction of an angiotensin-II receptor blocker (irbesartan) in a 66-year-old Caucasian diabetic male patient with bilateral renal stenosis and a right-sided single-functioning kidney, with a rapid improvement of the renal function which normalized 5 days after percutaneous angioplasty and stenting of the right renal artery.
Collapse
Affiliation(s)
- Claire Seydoux
- Department of Internal Medicine, University and Hospital of Fribourg, Fribourg, Switzerland
| | - Ould Maouloud Hemett
- Service of Nephrology, University and Hospital of Fribourg, Fribourg, Switzerland
| | - Daniel Périard
- Service of Angiology, University and Hospital of Fribourg, Fribourg, Switzerland
| | - Eric Descombes
- Service of Nephrology, University and Hospital of Fribourg, Fribourg, Switzerland
| |
Collapse
|
3
|
Calinoiu A, Guluta EC, Rusu A, Minca A, Minca D, Tomescu L, Gheorghita V, Minca DG, Negreanu L. Accessory renal arteries - a source of hypertension: A case report. World J Clin Cases 2023. [DOI: 10.12998/wjcc.v11.i7.1506
bcc:009247.186-63860.186.92a54.19420.2@bxss.me] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/04/2023] Open
|
4
|
Calinoiu A, Guluta EC, Rusu A, Minca A, Minca D, Tomescu L, Gheorghita V, Minca DG, Negreanu L. Accessory renal arteries - a source of hypertension: A case report. World J Clin Cases 2023; 11:1506-1512. [PMID: 36926389 PMCID: PMC10011986 DOI: 10.12998/wjcc.v11.i7.1506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 11/11/2022] [Accepted: 02/07/2023] [Indexed: 03/02/2023] Open
Abstract
BACKGROUND Secondary hypertension is a relatively rare condition most commonly caused by renovascular disease due to atherosclerotic vascular disease or fibromuscular dysplasia. Although accessory renal arteries are frequent, to date, only six cases of secondary hypertension determined by their existence have been reported.
CASE SUMMARY We describe a case of a 39-year-old female who came to the emergency department with an urgent hypertensive crisis and hypertensive encephalopathy. Despite normal renal arteries, the computed tomography angiography revealed an inferior polar artery with 50% stenosis of its diameter. Conservative treatment with amlodipine, indapamide and perindopril was adopted, leading to blood pressure control within one month.
CONCLUSION To the best of our knowledge, there are controversies regarding accessory renal arteries as a potential etiology for secondary hypertension, but the seven similar cases already described, along with the current case, could reinforce the necessity of more studies concerning this subject.
Collapse
Affiliation(s)
- Amalia Calinoiu
- Department of Internal Medicine, Prof. Dr. Agrippa Ionescu Emergency Clinical Hospital, Bucuresti 011356, București, Romania
| | - Elena-Cristina Guluta
- Department of Gastroenterology, Bucharest University Emergency Hospital, Bucharest 050098, Romania
| | - Adina Rusu
- Department of Internal Medicine, Prof. Dr. Agrippa Ionescu Emergency Clinical Hospital, Bucuresti 011356, București, Romania
| | - Alexandra Minca
- Department of Internal Medicine Clinic, Bucharest University Emergency Hospital, Bucharest 050098, Romania
| | - Dragos Minca
- Department of Rheumatology Clinic, Center of Rheumatic Disease "Dr. Ion Stoia", Bucharest 030167, Romania
| | - Luminita Tomescu
- Department of Radiology Clinic, Prof. Dr. Agrippa Ionescu Clinical Emergency Hospital, Bucharest 011356, Romania
| | - Valeriu Gheorghita
- Department of Infectious Disease Clinic, Prof Dr. Agrippa Ionescu Clinical Emergency Hospital, Bucharest 011356, Romania
| | - Dana Galieta Minca
- Department of Public Health and Management, Carol Davila University of Medicine and Pharmacy, Bucharest 020021, Romania
| | - Lucian Negreanu
- Department of Gastroenterology, Carol Davila University of Medicine and Pharmacy, Bucharest 020021, Romania
| |
Collapse
|
5
|
Calinoiu A, Guluta EC, Rusu A, Minca A, Minca D, Tomescu L, Gheorghita V, Minca DG, Negreanu L. Accessory renal arteries - a source of hypertension: A case report. World J Clin Cases 2023. [DOI: 10.12998/wjcc.v11.i7.1506
bcc:009247.186-3343.186.9f95e.19420.2@bxss.me] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/04/2023] Open
|
6
|
Calinoiu A, Guluta EC, Rusu A, Minca A, Minca D, Tomescu L, Gheorghita V, Minca DG, Negreanu L. Accessory renal arteries - a source of hypertension: A case report. World J Clin Cases 2023. [DOI: 10.12998/wjcc.v11.i7.1506
bcc:009247.186-127021.186.264be.19420.2@bxss.me] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/04/2023] Open
|
7
|
Calinoiu A, Guluta EC, Rusu A, Minca A, Minca D, Tomescu L, Gheorghita V, Minca DG, Negreanu L. Accessory renal arteries - a source of hypertension: A case report. World J Clin Cases 2023. [DOI: ./10.12998/wjcc.v11.i7.1506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/04/2023] Open
|
8
|
Triantis G, Chalikias GK, Ioannides E, Dagre A, Tziakas DN. Renal Artery Revascularization a controversial treatment strategy for Renal Artery Stenosis. A case series and a brief review of current literature. Hellenic J Cardiol 2022; 65:42-48. [PMID: 35341971 DOI: 10.1016/j.hjc.2022.03.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 02/24/2022] [Accepted: 03/19/2022] [Indexed: 11/04/2022] Open
Abstract
Renal artery stenosis (RAS) may cause secondary hypertension, progressive decline in renal function, and cardiac destabilization syndromes including "flash" pulmonary edema, recurrent congestive heart failure, and cerebro-cardiovascular disease. Atherosclerotic lesions, fibromuscular dysplasia and vasculitides are the pathophysiologic basis of the disease. Common therapeutic pathways for RAS include medical therapy and revascularization with or without stenting. Randomized controlled trials evaluating renal revascularization, did not report any advantage of revascularization over medical therapy alone in terms of renal function improvement or prevention of cardiovascular events. However, mounting clinical experience suggests that the best strategy in RAS management is identifying which patients are most likely to benefit from renal artery stenting and also optimizing the safety and durability of the procedure. This review presents 3 cases of patients who undergone renal revascularization and discusses the available clinical evidence for identification of RAS patients who will potentially respond well to revascularization.
Collapse
Affiliation(s)
| | - Georgios K Chalikias
- Department of Cardiology, Medical School, Democritus University of Thrace, Alexandroupolis
| | | | - Anna Dagre
- Department of Cardiology, Thriassio General Hospital, Athens, Greece
| | - Dimitrios N Tziakas
- Department of Cardiology, Medical School, Democritus University of Thrace, Alexandroupolis.
| |
Collapse
|
9
|
Salvage from hemodialysis via percutaneous transluminal renal artery stenting for a jeopardized solitary functioning kidney: A case report. J Cardiol Cases 2021; 24:268-271. [PMID: 34917207 DOI: 10.1016/j.jccase.2021.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 04/17/2021] [Accepted: 04/25/2021] [Indexed: 11/20/2022] Open
Abstract
Atherosclerotic renal artery stenosis (ARAS) causes resistant hypertension, progressively declining renal function, and cardiac destabilization syndromes, including heart failure. We report a patient who underwent successful percutaneous transluminal renal angioplasty (PTRA) for anuretic acute kidney injury (AKI) due to ARAS. This patient, admitted to our hospital with congestive heart failure, developed anuretic AKI and started hemodialysis 3 days after admission. Computed tomography and magnetic resonance angiograms showed total occlusion of the proximal right renal artery, with atrophy of the right kidney and severe stenosis of the proximal left renal artery. These findings suggested that only the left kidney was functioning. We performed PTRA of the left renal artery in which the culprit lesion causing the AKI appeared to be located. Using intravascular ultrasound, severe calcification in the ostium of the left renal artery and a necrotic core with plaque rupture in the culprit lesion were observed. Kidney function recovered immediately after revascularization, which permitted successful withdrawal of hemodialysis. There is no clear consensus regarding the indication for PTRA in patients with ARAS; however, our experience suggests that PTRA may be beneficial for patients with a jeopardized solitary functioning kidney. <Learning objective: There is no clear consensus regarding the indication for percutaneous transluminal renal angioplasty (PTRA) in patients with atherosclerotic renal artery stenosis. However, patients with a jeopardized solitary functioning kidney may benefit from PTRA, which should be considered as soon as possible before irreversible ischemic changes occur. It is important to recognize that PTRA may be indicated in select similar cases.>.
Collapse
|
10
|
Lestari S, Prasanto H, Kuswadi I. Renovascular Hypertension in Chronic Hemodialytic Patient. Open Access Maced J Med Sci 2021. [DOI: 10.3889/oamjms.2021.6741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background: Hypertension is a major contributor to the development of chronic kidney disease. Data in Indonesia, hypertension is still the most comorbid disease in CKD patients on dialysis (51%). Hypertension in CKD on dialysis patients is common and often uncontrolled. Renovascular hypertension is the most common cause of secondary hypertension. Diagnosis and treatment of RAS is very important, because it can accelerate the achievement of blood pressure targets, reduce the risk and complications due to hypertension.
Case Report: A 52-year-old woman with CKD has been undergoing hemodialysis for 2 years. Hypertension that was previously well controlled for 2 years required an increase in antihypertensive therapy from 2 to 4 drugs in recent months. On physical examination the blood pressure 180/90 mmHg, pulse 79 bpm, respiration 20/min, temperature 36.7oC. Conjunctiva looks anemic, cardiomegaly, lungs within normal limits, no ascites and edema in the extremities. On renal artery duplex ultrasound examination, right main renal artery acceleration time 147.65 ms, Peak Systolic Velocity (PSV) 31.9 cm/s. RI 0.69 and left main renal artery acceleration time 120.81 ms, PSV 16.9 cm/s, RI 0.61. There was 20-30% left renal artery stenosis, 80% right renal artery stenosis. A stent was placed on the right renal artery. The patient's condition after PTRA improved, but at the next follow-up, mean systole and diastole 170 mmHg and 80 mmHg, respectively. Patient received 4 antihypertensive therapy.
Conclusion: Renal artery stenosis is a disease that consists of a broad spectrum of different entities with different pathophysiologies that require varied approaches to diagnose and treat. Current diagnostic tools include MRA, CTA and renal artery duplex ultrasonography. Patients with renal parenchymal disease are poorer candidates for revascularization.
Collapse
|
11
|
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.
Collapse
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
| |
Collapse
|
12
|
Sasaki Y, Mishima E, Kikuchi K, Toyohara T, Suzuki T, Ota H, Seiji K, Miyazaki M, Harigae H, Ito S, Takase K, Abe T. Treatment of Refractory Hypertension with Timely Angioplasty in Total Renal Artery Occlusion with Atrophic Kidney. Intern Med 2021; 60:287-292. [PMID: 32830180 PMCID: PMC7872794 DOI: 10.2169/internalmedicine.5290-20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Angioplasty for cases of chronic total occlusion of renal artery with/without atrophic kidney is generally not recommended. We herein report a 57-year-old man who presented with renin-mediated refractory hypertension caused by occlusion of a unilateral renal artery leading to kidney atrophy (length: 69 mm). Angioplasty favorably achieved blood pressure control with normalized renin secretion and enlargement of the atrophic kidney to 85 mm. Timely angioplasty can be beneficial in select patients, even with an atrophic kidney and total occlusion, especially in cases with deterioration of hypertension within six months and the presence of collateral perfusion to the affected kidney.
Collapse
Affiliation(s)
| | - Eikan Mishima
- Division of Nephrology, Endocrinology, and Vascular Medicine, Tohoku University Graduate School of Medicine, Japan
| | - Koichi Kikuchi
- Division of Nephrology, Endocrinology, and Vascular Medicine, Tohoku University Graduate School of Medicine, Japan
| | - Takafumi Toyohara
- Division of Nephrology, Endocrinology, and Vascular Medicine, Tohoku University Graduate School of Medicine, Japan
| | - Takehiro Suzuki
- Division of Nephrology, Endocrinology, and Vascular Medicine, Tohoku University Graduate School of Medicine, Japan
| | - Hideki Ota
- Department of Diagnostic Radiology, Tohoku University Graduate School of Medicine, Japan
| | - Kazumasa Seiji
- Department of Diagnostic Radiology, Tohoku University Graduate School of Medicine, Japan
| | - Mariko Miyazaki
- Division of Nephrology, Endocrinology, and Vascular Medicine, Tohoku University Graduate School of Medicine, Japan
| | - Hideo Harigae
- Division of Nephrology, Endocrinology, and Vascular Medicine, Tohoku University Graduate School of Medicine, Japan
- Department of Hematology and Rheumatology, Tohoku University Graduate School of Medicine, Japan
| | - Sadayoshi Ito
- Division of Nephrology, Endocrinology, and Vascular Medicine, Tohoku University Graduate School of Medicine, Japan
- Department of Medicine, Katta Public General Hospital, Japan
| | - Kei Takase
- Department of Diagnostic Radiology, Tohoku University Graduate School of Medicine, Japan
| | - Takaaki Abe
- Division of Nephrology, Endocrinology, and Vascular Medicine, Tohoku University Graduate School of Medicine, Japan
- Division of Medical Science, Tohoku University Graduate School of Biomedical Engineering, Japan
- Department of Clinical Biology and Hormonal Regulation, Tohoku University Graduate School of Medicine, Japan
| |
Collapse
|
13
|
Wang X, Wang S, Pang YP, Jiang T, Yu C, Li Y, Shi B. Contrast-Enhanced Ultrasound Assessment of Renal Parenchymal Perfusion in Patients with Atherosclerotic Renal Artery Stenosis to Predict Renal Function Improvement After Revascularization. Int J Gen Med 2020; 13:1713-1721. [PMID: 33408509 PMCID: PMC7781108 DOI: 10.2147/ijgm.s293316] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Accepted: 12/15/2020] [Indexed: 12/29/2022] Open
Abstract
Background Identifying patients with atherosclerotic renal artery stenosis (ARAS) who will be improved in renal function after percutaneous transluminal renal artery stenting (PTRAS) is crucial since most patients show no worthwhile benefit of PTRAS. Although the assessment of renal parenchymal perfusion is useful for the identification, few studies predict the renal functional improvement by evaluating the characteristics of renal perfusion. Objective The aim of this study was to assess the renal parenchymal perfusion in ARAS patients with contrast-enhanced ultrasonography (CEUS) and predict the benefits of renal function after PTRAS utilizing time-intensity curve (TIC) parameters. Methods Thirty-eight kidneys in 30 ARAS patients received PTRAS in this study. They were divided into moderate stenosis group (n=25) and severe stenosis group (n=13) and mild dysfunction group (n=14) and moderate dysfunction group (n=24) according to the degree of renal stenosis and radioisotope glomerular filtration rate (rGFR). The baseline assessment of renal function and renal parenchymal perfusion were performed for all patients. rGFR was repeated to evaluate the renal outcome at 4 months after PTRAS. The outcome of PTRAS was classified as improved, stable, or deteriorated compared to the baseline. Time-intensity curve (TIC) parameters obtained from CEUS were analyzed to evaluate the predictive accuracy. Results TIC parameters (AUC and PI) were positively correlated with renal function (r=0.617, 0.663; P<0.05) but weakly and negatively correlated with the stenosis (r=−0.360, −0.435; P<0.05). Baseline rGFR was not accurate in predicting improved renal function after PTRAS (0.670). The accuracy of the combined prediction model of baseline AUC and PI (0.889) was higher than the individual indicators (baseline AUC: 0.855 and PI: 0.782). Conclusion CEUS could accurately assess renal parenchymal perfusion and identify ARAS patients with potential benefit after PTRAS. The combination of TIC parameters (AUC and PI) is valuable in the prediction of improved renal function after PTRAS.
Collapse
Affiliation(s)
- Xiuyan Wang
- Department of Ultrasonography, Tongji Hospital of Tongji University, Shanghai, People's Republic of China
| | - Shuo Wang
- Department of Ultrasonography, Tongji Hospital of Tongji University, Shanghai, People's Republic of China
| | - Yan-Ping Pang
- Department of Ultrasonography, Tongji Hospital of Tongji University, Shanghai, People's Republic of China
| | - Tian Jiang
- Department of Ultrasonography, Tongji Hospital of Tongji University, Shanghai, People's Republic of China
| | - Chen Yu
- Department of Nephrology, Tongji Hospital of Tongji University, Shanghai, People's Republic of China
| | - Yuan Li
- Department of Ultrasonography, Tongji Hospital of Tongji University, Shanghai, People's Republic of China
| | - Baomin Shi
- Department of General Surgery, Tongji Hospital of Tongji University, Shanghai, People's Republic of China
| |
Collapse
|
14
|
Ai H, Zhang HP, Yang GJ, Zheng NX, Tang GD, Li H, Zhou Q, Ren JH, Zhao Y, Sun FC. <p>Severely Impaired Renal Function in Unilateral Atherosclerotic Renal Artery Stenosis Indicated by Renal Slow Perfusion</p>. Int J Gen Med 2020; 13:839-845. [PMID: 33116776 PMCID: PMC7569045 DOI: 10.2147/ijgm.s279457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Accepted: 09/23/2020] [Indexed: 11/23/2022] Open
Affiliation(s)
- Hu Ai
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Beijing, 100730, China
| | - Hui-Ping Zhang
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Beijing, 100730, China
| | - Guo-Jian Yang
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Beijing, 100730, China
| | - Nai-Xin Zheng
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Beijing, 100730, China
| | - Guo-Dong Tang
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Beijing, 100730, China
| | - Hui Li
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Beijing, 100730, China
| | - Qi Zhou
- The MOH Key Laboratory of Geriatrics, Beijing Hospital, National Center of Gerontology, Beijing, 100730, China
| | - Jun-Hong Ren
- Department of Sonography, Beijing Hospital, National Center of Gerontology, Beijing, 100730, China
| | - Ying Zhao
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Beijing, 100730, China
- Correspondence: Ying Zhao; Fu-Cheng Sun Department of Cardiology, Beijing Hospital, National Center of Gerontology, No. 1 DaHua Road, Dong Dan, Beijing100730, ChinaTel +86 15901059087; Tel +86 15901059087 Email ;
| | - Fu-Cheng Sun
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Beijing, 100730, China
| |
Collapse
|