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Zhao Y, Shi Y, Jin Y, Cao Y, Song H, Chen L, Li F, Li X, Chen W. Evaluating Short-Term and Long-Term Risks Associated with Renal Artery Stenosis Position and Severity: A Hemodynamic Study. Bioengineering (Basel) 2023; 10:1002. [PMID: 37760104 PMCID: PMC10525140 DOI: 10.3390/bioengineering10091002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 08/16/2023] [Accepted: 08/21/2023] [Indexed: 09/29/2023] Open
Abstract
Background: Moderate renal artery stenosis (50-70%) may lead to uncontrolled hypertension and eventually cause irreversible damage to renal function. However, the clinical criteria for interventional treatment are still ambiguous in this condition. This study investigated the impact of the position and degree of renal artery stenosis on hemodynamics near the renal artery to assess the short-term and long-term risks associated with this disease. Methods: Calculation models with different degrees of stenosis (50%, 60%, and 70%) located at different positions in the right renal artery were established based on the computed tomography angiography (CTA) of a personalized case. And computational fluid dynamics (CFD) was used to analyze hemodynamic surroundings near the renal artery. Results: As the degree of stenosis increases and the stenosis position is far away from the aorta, there is a decrease in renal perfusion. An analysis of the wall shear stress (WSS)-related parameters indicated areas near the renal artery (downstream of the stenosis and the entrance of the right renal artery) with potential long-term risks of thrombosis and inflammation. Conclusion: The position and degree of stenosis play a significant role in judging short-term risks associated with renal perfusion. Moreover, clinicians should consider not only short-term risks but also independent long-term risk factors, such as certain regions of 50% stenosis with adequate renal perfusion may necessitate prompt intervention.
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Affiliation(s)
- Yawei Zhao
- College of Biomedical Engineering, Taiyuan University of Technology, Taiyuan 030024, China; (Y.Z.); (Y.S.); (Y.J.); (Y.C.); (X.L.); (W.C.)
| | - Yike Shi
- College of Biomedical Engineering, Taiyuan University of Technology, Taiyuan 030024, China; (Y.Z.); (Y.S.); (Y.J.); (Y.C.); (X.L.); (W.C.)
| | - Yusheng Jin
- College of Biomedical Engineering, Taiyuan University of Technology, Taiyuan 030024, China; (Y.Z.); (Y.S.); (Y.J.); (Y.C.); (X.L.); (W.C.)
| | - Yifan Cao
- College of Biomedical Engineering, Taiyuan University of Technology, Taiyuan 030024, China; (Y.Z.); (Y.S.); (Y.J.); (Y.C.); (X.L.); (W.C.)
| | - Hui Song
- College of Mechanical and Vehicle Engineering, Taiyuan University of Technology, Taiyuan 030024, China;
- Institute of Applied Mechanics, Taiyuan University of Technology, Taiyuan 030024, China
| | - Lingfeng Chen
- College of Biomedical Engineering, Taiyuan University of Technology, Taiyuan 030024, China; (Y.Z.); (Y.S.); (Y.J.); (Y.C.); (X.L.); (W.C.)
| | - Fen Li
- College of Mechanical and Vehicle Engineering, Taiyuan University of Technology, Taiyuan 030024, China;
- Institute of Applied Mechanics, Taiyuan University of Technology, Taiyuan 030024, China
| | - Xiaona Li
- College of Biomedical Engineering, Taiyuan University of Technology, Taiyuan 030024, China; (Y.Z.); (Y.S.); (Y.J.); (Y.C.); (X.L.); (W.C.)
| | - Weiyi Chen
- College of Biomedical Engineering, Taiyuan University of Technology, Taiyuan 030024, China; (Y.Z.); (Y.S.); (Y.J.); (Y.C.); (X.L.); (W.C.)
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Hernandez AM, Burkett GW, Pham N, Abbey CK, Boone JM. Performance of high-resolution CT for detection and discrimination tasks related to stenotic lesions - A phantom study using model observers. Med Phys 2022; 50:2037-2048. [PMID: 36583447 DOI: 10.1002/mp.16194] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 12/04/2022] [Accepted: 12/15/2022] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Accurate detection and grading of atheromatous stenotic lesions within the cardiac, renal, and intracranial vasculature is imperative for early recognition of disease and guiding treatment strategies. PURPOSE In this work, a stenotic lesion phantom was used to compare high resolution and normal resolution modes on the same CT scanner in terms of detection and size discrimination performance. MATERIALS AND METHODS The phantom is comprised of three acrylic cylinders (each 15.0 cm in diameter and 1.3 cm thick) with a matching array of holes in each module. The outer two modules contain holes that are slightly larger than the corresponding hole in the central module to simulate stenotic narrowing in vasculature. The stack of modules was submerged in an iodine solution simulating contrast-enhanced stenotic lesions with a range of lumen diameters (1.32-10.08 mm) and stenosis severity (0%, 50%, 60%, 70%, and 80%). The phantom was imaged on the Canon Aquilion Precision high-resolution CT scanner in high-resolution (HR) mode (0.25 mm × 0.50 mm detector element size) and normal-resolution (NR) mode (0.50 mm × 0.50 mm) using 120 kV and two dose levels (14 and 21 mGy SSDE) with 30 repeat scans acquired for each combination. Filtered back-projection (FBP) and a hybrid-iterative reconstruction (AIDR) were used with the FC18 kernel, as well as a deep learning algorithm (AiCE) which is only available for HR. A non-prewhitening model observer with an eye filter was implemented to quantify performance for detection and size discrimination tasks in the axial plane. RESULTS Detection performance improved with increasing diameter, dose, and for AIDR in comparison to FBP for a fixed resolution mode. Performance in the HR mode was generally higher than NR for the smaller lumen diameters (1-5 mm) with decreasing differences as the diameter increased. Performance in NR mode surpassed HR mode for lumen diameters greater than ∼4 mm and ∼5 mm for 14 mGy and 21 mGy, respectively. AiCE provided consistently higher detection performance compared with AIDR-FC18 (48% higher for a 6 mm lumen diameter). Discrimination performance increased with increasing nominal diameter, dose, and for larger differences in stenosis severity. When comparing discrimination performance in HR to NR modes, the largest relative differences occur at the smallest nominal diameters and smallest differences in stenosis severity. The AiCE reconstruction algorithm produced the highest overall discrimination performance values, and these were significantly higher than AIDR-FC18 for nominal diameters of 7.14 and 10.08 mm. CONCLUSIONS HR mode outperforms NR for detection up to a specific diameter and the results improve with AiCE and for higher dose levels. For the task of size discrimination, HR mode consistently outperforms NR if AIDR-FC18 is used for dose levels of at least 21 mGy, and the results improve with AiCE and for the smallest differences in stenosis severity investigated (50% vs. 60%). High-resolution CT appears to be beneficial for detecting smaller simulated lumen diameters (<5 mm) and is generally advantageous for discrimination tasks related to stenotic lesions, which inherently contain information at higher frequencies, given the right reconstruction algorithm and dose level.
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Affiliation(s)
- Andrew M Hernandez
- Department of Radiology, University of California Davis, Sacramento, California, USA
| | - George W Burkett
- Department of Radiology, University of California Davis, Sacramento, California, USA
| | - Nancy Pham
- Department of Radiology, University of California Los Angeles, Los Angeles, California, USA
| | - Craig K Abbey
- Department of Psychological & Brain Sciences, University of California Santa Barbara, Santa Barbara, California, USA
| | - John M Boone
- Department of Radiology, University of California Davis, Sacramento, California, USA.,Department of Biomedical Engineering, University of California Davis, Davis, California, USA
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Ultrasonographic Assessment of Atherosclerotic Renal Artery Stenosis in Elderly Patients with Chronic Kidney Disease: An Italian Cohort Study. Diagnostics (Basel) 2022; 12:diagnostics12061454. [PMID: 35741264 PMCID: PMC9222028 DOI: 10.3390/diagnostics12061454] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 06/05/2022] [Accepted: 06/08/2022] [Indexed: 12/24/2022] Open
Abstract
Although atherosclerotic renal artery stenosis (ARAS) is strictly associated with high cardiovascular risk and mortality, it often may remain unrecognized being clinically silent and frequently masked by co-morbidities especially in elderly patients with coexisting chronic kidney disease (CKD). The present observational study was conducted in elderly CKD-patients with atherosclerosis on other arterial beds. The aims were assessment of (1) ARAS prevalence; (2) best predictor(s) of ARAS, using duplex ultrasound; and (3) cardiovascular and renal outcomes at one-year follow-up. The cohort was represented by 607 consecutive in-patients. Inclusion criteria were age ≥65 years; CKD stages 2−5 not on dialysis; single or multiple atherosclerotic plaque on epiaortic vessels, abdominal aorta, aortic arch, coronary arteries, peripheral arteries that had been previously ascertained by one or more procedures. Duplex ultrasound was used to detect ARAS. Multiple regression analysis and ROS curve were performed to identify the predictors of ARAS. ARAS was found in 53 (44%) out of 120 patients who met the inclusion criteria. In univariate analysis, GFR (b = −0.021; p = 0.02); hemoglobin (b = −0.233; p = 0.02); BMI (b = 0.134; p = 0.036) and atherosclerosis of abdominal aorta and/or peripheral vessels (b = 1.025; p < 0.001) were associated with ARAS. In multivariable analysis, abdominal aorta and/or peripheral atherosclerosis was a significant (p = 0.002) predictor of ARAS. The area under the ROC curve was 0.655 (C.I. = 0.532−0.777; p = 0.019). ARAS is common in older CKD patients with extra-renal atherosclerosis, with the highest prevalence in those with aortic and peripheral atherosclerosis. ARAS may pass by unnoticed in everyday clinical practice.
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Emergent players in renovascular disease. Clin Sci (Lond) 2022; 136:239-256. [PMID: 35129198 DOI: 10.1042/cs20210509] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 01/25/2022] [Accepted: 01/26/2022] [Indexed: 02/07/2023]
Abstract
Renovascular disease (RVD) remains a common etiology of secondary hypertension. Recent clinical trials revealed unsatisfactory therapeutic outcomes of renal revascularization, leading to extensive investigation to unravel key pathophysiological mechanisms underlying irreversible functional loss and structural damage in the chronically ischemic kidney. Research studies identified complex interactions among various players, including inflammation, fibrosis, mitochondrial injury, cellular senescence, and microvascular remodeling. This interplay resulted in a shift of our understanding of RVD from a mere hemodynamic disorder to a pro-inflammatory and pro-fibrotic pathology strongly influenced by systemic diseases like metabolic syndrome (MetS), hypertension, diabetes mellitus, and hyperlipidemia. Novel diagnostic approaches have been tested for early detection and follow-up of RVD progression, using new imaging techniques and biochemical markers of renal injury and dysfunction. Therapies targeting some of the pathological pathways governing the development of RVD have shown promising results in animal models, and a few have moved from bench to clinical research. This review summarizes evolving understanding in chronic ischemic kidney injury.
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Lau LHY, Nano J, Prehn C, Cecil A, Rathmann W, Zeller T, Lechner A, Adamski J, Peters A, Thorand B. Associations of endogenous androgens and sex hormone-binding globulin with kidney function and chronic kidney disease. Front Endocrinol (Lausanne) 2022; 13:1000650. [PMID: 36601008 PMCID: PMC9807167 DOI: 10.3389/fendo.2022.1000650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 12/01/2022] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION The role of endogenous androgens in kidney function and disease has not been extensively explored in men and women. RESEARCH DESIGN AND METHODS We analyzed data from the observational KORA F4 study and its follow-up examination KORA FF4 (median follow-up time 6.5 years) including 1293 men and 650 peri- and postmenopausal women, not using exogenous sex hormones. We examined the associations between endogenous androgens (testosterone [T], dihydrotestosterone [DHT], free T [fT], free DHT [fDHT], and T/DHT), with estimated glomerular filtration rate (eGFR) at baseline and follow-up, prevalent, and incident chronic kidney disease (CKD) adjusting for common CKD risk factors. RESULTS At baseline, 73 men (5.7%) and 54 women (8.4%) had prevalent CKD. Cross-sectionally, no significant associations between androgens and kidney function were observed among men. In women, elevated T (β=-1.305, [95% CI -2.290; -0.320]) and fT (β=-1.423, [95% CI -2.449; -0.397]) were associated with lower eGFR. Prospectively, 81 men (8.8%) and 60 women (15.2%) developed incident CKD. In women, a reverse J-shaped associations was observed between DHT and incident CKD (Pnon-linear=0.029), while higher fDHT was associated with lower incident CKD risk (odds ratio per 1 standard deviation=0.613, [95% CI 0.369; 0.971]. Among men, T/DHT (β=-0.819, [95% CI -1.413; -0.226]) and SHBG (Pnon-linear=0.011) were associated with eGFR at follow-up but not with incident CKD. Some associations appeared to be modified by type 2 diabetes (T2D). CONCLUSION Suggestive associations are observed of androgens and SHBG with kidney impairment among men and women. However, larger well-phenotyped prospective studies are required to further elucidate the potential of androgens, SHBG, and T2D as modifiable risk factors for kidney function and CKD.
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Affiliation(s)
- Lina Hui Ying Lau
- Institute of Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, Germany
- Institute for Medical Information Processing, Biometry, and Epidemiology (IBE), Ludwig-Maximilians-Universität (LMU), Munich, Germany
- International Helmholtz Research School for Diabetes, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
| | - Jana Nano
- Institute of Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, Germany
- Chair of Epidemiology, Institute for Medical Information Processing, Biometry and Epidemiology, Medical Faculty, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Cornelia Prehn
- Metabolomics and Proteomics Core, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
| | - Alexander Cecil
- Metabolomics and Proteomics Core, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
| | - Wolfgang Rathmann
- German Center for Diabetes Research (DZD), Partner Site Düsseldorf, Düsseldorf, Germany
- Institute for Biometrics and Epidemiology, German Diabetes Center (DDZ), Leibniz Center for Diabetes Research at Heinrich Heine Universität, Düsseldorf, Germany
| | - Tanja Zeller
- University Center of Cardiovascular Science, University Heart and Vascular Center Hamburg, Department of Cardiology, University Medical Center Hamburg, Hamburg, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site, Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Andreas Lechner
- Medizinische Klinik und Poliklinik IV, Ludwig-Maximilians-Universität (LMU), München, Germany
| | - Jerzy Adamski
- Institute of Experimental Genetics, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
- Department of Biochemistry, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Institute of Biochemistry, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Annette Peters
- Institute of Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, Germany
- Chair of Epidemiology, Institute for Medical Information Processing, Biometry and Epidemiology, Medical Faculty, Ludwig-Maximilians-Universität München, Munich, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, München, Germany
- German Center for Diabetes Research (DZD), Partner Site Munich-Neuherberg, Neuherberg, Germany
| | - Barbara Thorand
- Institute of Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, Germany
- German Center for Diabetes Research (DZD), Partner Site Munich-Neuherberg, Neuherberg, Germany
- *Correspondence: Barbara Thorand,
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Gunawardena T. Atherosclerotic Renal Artery Stenosis: A Review. AORTA : OFFICIAL JOURNAL OF THE AORTIC INSTITUTE AT YALE-NEW HAVEN HOSPITAL 2021; 9:95-99. [PMID: 34638148 PMCID: PMC8598311 DOI: 10.1055/s-0041-1730004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Renal artery stenosis (RAS) is associated with hypertension and renal impairment. Atherosclerosis is the leading etiologic factor which accounts for >90% of the cases. Those with atherosclerotic RAS (ARAS) tend to have concomitant atherosclerosis in other vascular beds, so they are at a high risk of adverse coronary and cerebrovascular events. Management of ARAS is controversial, with limited indications for revascularization. In this review, the author aims to discuss the pathophysiology, natural history, diagnosis, and management of ARAS.
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Affiliation(s)
- Thilina Gunawardena
- Department of Vascular and Transplant Surgery, National Hospital of Colombo, Sri Lanka
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7
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Renin-Angiotensin System Induced Secondary Hypertension: The Alteration of Kidney Function and Structure. Int J Nephrol 2021. [PMID: 31628476 PMCID: PMC8505109 DOI: 10.1155/2021/5599754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Long-term hypertension is known as a major risk factor for cardiovascular and chronic kidney disease (CKD). The Renin-angiotensin system (RAS) plays a key role in hypertension pathogenesis. Angiotensin II (Ang II) enhancement in Ang II-dependent hypertension leads to progressive CKD and kidney fibrosis. In the two-kidney one-clip model (2K1C), more renin is synthesized in the principal cells of the collecting duct than juxtaglomerular cells (JGCs). An increase of renal Ang I and Ang II levels and a decrease of renal cortical and medullary Ang 1–7 occur in both kidneys of the 2K1C hypertensive rat model. In addition, the activity of the angiotensin-converting enzyme (ACE) increases, while ACE2's activity decreases in the medullary region of both kidneys in the 2K1C hypertensive model. Also, the renal prolyl carboxypeptidase (PrCP) expression and its activity reduce in the clipped kidneys. The imbalance in the production of renal ACE, ACE2, and PrCP expression causes the progression of renal injury. Intrarenal angiotensinogen (AGT) expression and urine AGT (uAGT) excretion rates in the unclipped kidney are greater than the clipped kidney in the 2K1C hypertensive rat model. The enhancement of Ang II in the clipped kidney is related to renin secretion, while the elevation of intrarenal Ang II in the unclipped kidney is related to stimulation of AGT mRNA and protein in proximal tubule cells by a direct effect of systemic Ang II level. Ang II-dependent hypertension enhances macrophages and T-cell infiltration into the kidney which increases cytokines, and AGT synthesis in proximal tubules is stimulated via cytokines. Accumulation of inflammatory cells in the kidney aggravates hypertension and renal damage. Moreover, Ang II-dependent hypertension alters renal Ang II type 1 & 2 receptors (AT1R & AT2R) and Mas receptor (MasR) expression, and the renal interstitial fluid bradykinin, nitric oxide, and cGMP response to AT1R, AT2R, or BK B2-receptor antagonists. Based on a variety of sources including PubMed, Google Scholar, Scopus, and Science-Direct, in the current review, we will discuss the role of RAS-induced secondary hypertension on the alteration of renal function.
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Ramaswamy R, Wee SN, George K, Ghosh A, Sarkar J, Burghaus R, Lippert J. CKD subpopulations defined by risk-factors: A longitudinal analysis of electronic health records. CPT-PHARMACOMETRICS & SYSTEMS PHARMACOLOGY 2021; 10:1343-1356. [PMID: 34510793 PMCID: PMC8592509 DOI: 10.1002/psp4.12695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 05/24/2021] [Accepted: 06/21/2021] [Indexed: 12/05/2022]
Abstract
Chronic kidney disease (CKD) is a progressive disease that evades early detection and is associated with various comorbidities. Although clinical comprehension and control of these comorbidities is crucial for CKD management, complex pathophysiological interactions and feedback loops make this a formidable task. We have developed a hybrid semimechanistic modeling methodology to investigate CKD progression. The model is represented as a system of ordinary differential equations with embedded neural networks and takes into account complex disease progression pathways, feedback loops, and effects of 53 medications to generate time trajectories of eight clinical biomarkers that capture CKD progression due to various risk factors. The model was applied to real world data of US patients with CKD to map the available longitudinal information onto a set of time‐invariant patient‐specific parameters with a clear biological interpretation. These parameters describing individual patients were used to segment the cohort using a clustering approach. Model‐based simulations were conducted to investigate cluster‐specific treatment strategies. The model was able to reliably reproduce the variability in biomarkers across the cohort. The clustering procedure segmented the cohort into five subpopulations – four with enhanced sensitivity to a specific risk factor (hypertension, hyperlipidemia, hyperglycemia, or impaired kidney) and one that is largely insensitive to any of the risk factors. Simulation studies were used to identify patient‐specific strategies to restrain or prevent CKD progression through management of specific risk factors. The semimechanistic model enables identification of disease progression phenotypes using longitudinal data that aid in prioritizing treatment strategies at individual patient level.
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Affiliation(s)
| | | | | | | | | | - Rolf Burghaus
- Pharmacometrics, Bayer AG - Pharmaceuticals, Wuppertal, Germany
| | - Jörg Lippert
- Pharmacometrics, Bayer AG - Pharmaceuticals, Wuppertal, Germany
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Hinojosa-Gonzalez DE, Salgado-Garza G, Torres-Martinez M, Villegas-De Leon SU, Bueno-Gutierrez LC, Herrera-Carrillo FE, Gonzalez-Urquijo M, Segura Ibarra V, Fabiani MA, Flores-Villalba E. Endovascular Treatment of Transplant Renal Artery Stenosis: A Systematic Review and Meta-analysis. J Endovasc Ther 2021; 29:294-306. [PMID: 34399594 DOI: 10.1177/15266028211038593] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Endovascular treatment through either percutaneous transluminal angioplasty (PTA) alone or stenting has been previously used as a treatment for transplant renal artery stenosis (TRAS). This review aimed to investigate the results of endovascular treatment for renal artery stenosis in transplanted kidneys as compared with the outcomes of interventions, medical management, and graft survival in non-TRAS patients. METHODS A systematic review of PubMed, Google Scholar, Cochrane, and Scopus was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines in which studies that reported outcomes of the treatment of TRAS via the endoluminal approach were identified, and their results were meta-analyzed. RESULTS Fifty-four studies with a total of 1522 patients were included. A significant reduction of serum creatinine level was found, favoring the stenting group, with a mean difference of 0.68 mg/dL (95% confidence interval (CI), 0.17-1.19; Z=2.60, p=0.0009). Comparison of pre- and post-intervention values of any intervention revealed a significant decrease in overall serum creatinine level (0.65 mg/dL; 95% CI, 0.40-0.90; Z=5.09, p=0.00001), overall blood pressure, with a mean difference of 11.12 mmHg (95% CI, 7.29-14.95; Z=5.59, p=0.00001), mean difference in the use of medications (0.77; 95% CI, 0.29-1.24; p=0.002), and peak systolic velocity (190.05; 95% CI, 128.41-251.69; p<0.00001). The comparison of serum creatinine level between endovascular interventions and best medical therapy favored endovascular intervention, with a mean difference of 0.23 mg/dL (95% CI, 0.14-0.32; Z=5.07, p<0.00001). Graft survival was similar between the treated patients and those without TRAS (hazard ratio, 0.98; 95% CI, 0.75-1.28; p=0.091). The overall pooled success rate was 89%, and the overall complication rate was 10.4%, with the most prevalent complication being arterial dissection. CONCLUSION The endovascular treatment of TRAS improves graft preservation and renal function and hemodynamic parameters. PTA + stenting appears to be a more effective option to PTA alone in the stabilization of renal function, with additional benefits from decreased restenosis rates. Further high-quality studies could expand on these findings.
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Affiliation(s)
| | - Gustavo Salgado-Garza
- Escuela de Medicina y Ciencias de la Salud, Tecnologico de Monterrey, Monterrey, NL, Mexico
| | | | | | | | | | | | - Victor Segura Ibarra
- Escuela de Medicina y Ciencias de la Salud, Tecnologico de Monterrey, Monterrey, NL, Mexico.,Escuela de Ingeniería y Ciencias, Tecnologico de Monterrey, Monterrey, NL, Mexico
| | | | - Eduardo Flores-Villalba
- Escuela de Medicina y Ciencias de la Salud, Tecnologico de Monterrey, Monterrey, NL, Mexico.,Escuela de Ingeniería y Ciencias, Tecnologico de Monterrey, Monterrey, NL, Mexico
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10
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Fu W, Tian X, Liu L, Zhang X, Wang X. Long noncoding RNA PR11-387H17.6 as a potential novel diagnostic biomarker of atherosclerotic renal artery stenosis. Ren Fail 2021; 43:1188-1197. [PMID: 34369281 PMCID: PMC8354168 DOI: 10.1080/0886022x.2021.1956537] [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] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND Atherosclerotic renal artery stenosis (ARAS) is frequently related to ischemic nephropathy, secondary hypertension, and end-stage renal failure. Thus, this study aimed to explore whether certain circulating long noncoding RNAs (lncRNAs) may be used as potential specific ARAS biomarkers. METHODS In the present study, a microarray analysis was performed to screen for lncRNAs in renal artery tissue from four ARAS patients and four non-ARAS individuals. To identify specific lncRNAs as candidate potential biomarkers of ARAS, we used the following criteria: the fold change was set to >3.0 (compared with non-ARAS tissues), and p value cutoff was set at .05. According to these criteria, six lncRNAs were identified from 1150 lncRNAs. After validation by quantitative PCR (qPCR), these lncRNAs were independently validated in blood from groups of 18 ARAS patients, 18 non-ARAS individuals, and 18 healthy volunteers, furthermore, the predictive value of lncRNA PR11-387H17.6 was further assessed using blood from groups of 99 ARAS patients, 49 non-ARAS individuals, and 50 healthy volunteers. A receiver operating characteristic (ROC) curve analysis was performed to assess the performance of these lncRNAs as biomarkers. RESULTS In the ROC analysis, the area under the curve (AUC) of PR11-387H17.6 was 0.733, with 52.5% sensitivity and 84.8% specificity in predicting the occurrence of ARAS. After considering the risk factors, the AUC of PR11-387H17.6 was 0.844, and the optimal sensitivity increased from 52.5% to 74.5%, although the specificity decreased from 84.8% to 81.9%. In the multivariable logistic analysis, PR11-387H17.6 was an independent predictor of major adverse events (OR: 3.039; 95% CI: 1.388-6.654; p= .006). CONCLUSIONS PR11-387H17.6 is a potential diagnostic biomarker of ARAS. The lncRNA levels in blood cells are regulated in ARAS. Thus, further investigations of the role of lncRNAs in ARAS are warranted.
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Affiliation(s)
- Wenxia Fu
- Department of Cardiac Function, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China.,Department of Cardiology and Institute of Cardiovascular Research, General Hospital of Northern Theater Command, Shenyang, China
| | - Xiaoxiang Tian
- Department of Cardiology and Institute of Cardiovascular Research, General Hospital of Northern Theater Command, Shenyang, China
| | - Liwen Liu
- Department of Cardiology and Institute of Cardiovascular Research, General Hospital of Northern Theater Command, Shenyang, China
| | - Xiaolin Zhang
- Department of Cardiology and Institute of Cardiovascular Research, General Hospital of Northern Theater Command, Shenyang, China
| | - Xiaozeng Wang
- Department of Cardiology and Institute of Cardiovascular Research, General Hospital of Northern Theater Command, Shenyang, China
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11
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Vemireddy LP, Ying GW, Aqeel A, Baig S, Buddharaju V. Is the Renal Resistive Index a Marker for Revascularization in Atherosclerotic Renal Artery Stenosis? Cureus 2021; 13:e14755. [PMID: 34094725 PMCID: PMC8169008 DOI: 10.7759/cureus.14755] [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] [Indexed: 11/18/2022] Open
Abstract
Renal artery stenosis (RAS) is one of the major causes of resistant/malignant hypertension. It can be described as atherosclerotic or non-atherosclerotic. Atherosclerotic RAS comprises almost 90% of all RAS cases and is a prevalent disease of the elderly. Multiple risk factors contribute to atherosclerosis development, which leads to the release of renin and aldosterone, causing resistant/malignant hypertension. Early recognition is prudent but challenging as there are no early clinical signs. We believe that renal resistive index with supportive clinical, laboratory, and imaging modalities can help select revascularization patients.
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Affiliation(s)
- Lalitha Padmanabha Vemireddy
- Internal Medicine, Chicago Medical School Internal Medicine Residency Program, Northwestern McHenry Hospital, Chicago, USA
| | - Grace W Ying
- Internal Medicine, Chicago Medical School Internal Medicine Residency Program, Northwestern McHenry Hospital, Chicago, USA
| | - Ammar Aqeel
- Internal Medicine, Chicago Medical School Internal Medicine Residency Program, Northwestern McHenry Hospital, Chicago, USA
| | - Shaji Baig
- Internal Medicine, Northwestern Medicine McHenry Hospital, Rosalind Franklin University of Medicine and Science, McHenry, USA
| | - Venkata Buddharaju
- Nephrology, Northwestern Medicine McHenry Hospital, Rosalind Franklin University of Medicine and Science, McHenry, USA
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12
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Dao K, Patel P, Pollock E, Mangano A, Gosal K. Ischemic Nephropathy Following Occlusion of Abdominal Aortic Aneurysm Graft: A Case Report. Cureus 2021; 13:e13799. [PMID: 33842171 PMCID: PMC8033647 DOI: 10.7759/cureus.13799] [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] [Indexed: 11/23/2022] Open
Abstract
In this report, we present a case of a 55-year-old female with a past medical history of abdominal aortic aneurysm (AAA) graft, femoral-femoral bypass graft, questionable history of chronic kidney disease (CKD), abdominal hernia repair, alcoholic pancreatitis, chronic abdominal pain on opioids, and tobacco abuse who presented with acute on chronic abdominal pain with an unexplained rise of creatinine and anuria. The patient was found to have complete occlusion of AAA graft and was determined to have ischemic nephropathy (IN).
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Affiliation(s)
- Kevin Dao
- Internal Medicine, Grand Strand Medical Center, Myrtle Beach, USA
| | - Pooja Patel
- Internal Medicine, Grand Strand Medical Center, Myrtle Beach, USA
| | - Erin Pollock
- Internal Medicine, Grand Strand Medical Center, Myrtle Beach, USA
| | - Andrew Mangano
- Internal Medicine, Grand Strand Medical Center, Myrtle Beach, USA
| | - Kiranpreet Gosal
- Internal Medicine, Grand Strand Medical Center, Myrtle Beach, USA
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13
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Koratala A, Chamarthi G, Touyz RM, Dominiczak AF, Elijovich F, Spence JD, Grim CE, Taler SJ, Mohandas R. Renovascular Hypertension: One Size Does Not Fit All: Challenges in Diagnosis and Management. Hypertension 2021; 77:1022-1028. [PMID: 33689462 DOI: 10.1161/hypertensionaha.121.17022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Abhilash Koratala
- From the Division of Nephrology (A.K.), Medical College of Wisconsin, Milwaukee.,Division of Nephrology, Hypertension and Renal Transplantation, University of Florida, Gainesville (A.K., G.C., R.M.)
| | - Gajapathiraju Chamarthi
- Division of Nephrology, Hypertension and Renal Transplantation, University of Florida, Gainesville (A.K., G.C., R.M.)
| | - Rhian M Touyz
- Institute of Cardiovascular and Medical Sciences, British Heart Foundation Glasgow Cardiovascular Research Centre (R.T.), University of Glasgow, United Kingdom
| | - Anna F Dominiczak
- Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary and Life Sciences (A.F.D.), University of Glasgow, United Kingdom
| | - Fernando Elijovich
- Department of Clinical Pharmacology, Vanderbilt University Medical Center, Nashville, TN (F.E.)
| | - J David Spence
- Stroke Prevention and Atherosclerosis Research Centre, Western University, London, Ontario, Canada (J.D.S.)
| | | | - Sandra J Taler
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN (S.J.T.)
| | - Rajesh Mohandas
- Division of Nephrology, Hypertension and Renal Transplantation, University of Florida, Gainesville (A.K., G.C., R.M.)
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14
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Alnahhal KI, Jarmi T, Hakaim AG, Farres H. Renal artery revascularization using the inferior mesenteric artery as an inflow source with a long-term follow-up. JOURNAL OF VASCULAR SURGERY CASES INNOVATIONS AND TECHNIQUES 2021; 7:223-225. [PMID: 33997558 PMCID: PMC8095123 DOI: 10.1016/j.jvscit.2021.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 02/21/2021] [Indexed: 11/24/2022]
Abstract
This case describes a 72-year-old woman with a history of chronic kidney disease stage III presented with bilateral renal artery stenosis with a progressively atrophied right kidney. At the time of surgery, the atrophied kidney was nonfunctional. Therefore, the patient underwent unilateral renal artery revascularization via the inferior mesenteric artery as an inflow. A 7-year follow-up revealed improvement in the kidney function and stabilization of blood pressure, which was controlled with less number of antihypertensive medications. In brief, open surgical correction of the renal artery stenosis using the inferior mesenteric artery as an inflow source can retrieve renal function in selected hypertensive patients with ischemic nephropathy.
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Affiliation(s)
- Khaled I Alnahhal
- Division of Vascular Surgery, Department of Surgery, Mayo Clinic Florida, Jacksonville, Fla
| | - Tambi Jarmi
- Division of Transplant Nephrology, Department of Internal Medicine, Mayo Clinic Florida, Jacksonville, Fla
| | - Albert G Hakaim
- Division of Vascular Surgery, Department of Surgery, Mayo Clinic Florida, Jacksonville, Fla
| | - Houssam Farres
- Division of Vascular Surgery, Department of Surgery, Mayo Clinic Florida, Jacksonville, Fla
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15
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Gameraddin M, Musa WI, Abdelmaboud S, Alshoabi S, Alsultan KD, Abdelmalik BA. Sonographic assessment of kidneys in patients with hypertension co-existed with diabetes mellitus and ischemic heart disease. J Family Med Prim Care 2020; 9:2411-2415. [PMID: 32754511 PMCID: PMC7380820 DOI: 10.4103/jfmpc.jfmpc_50_20] [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: 01/09/2020] [Revised: 03/12/2020] [Accepted: 04/02/2020] [Indexed: 11/04/2022] Open
Abstract
Background Hypertension is one of the major world health problems. Ultrasonography plays a useful role in the assessment of morphologicalchanges at the kidneys in hypertensive patients. Aim To assess sonographic findings of the kidneys in hypertensive patients' co-morbidities with type 2 diabetes mellitus and ischemic heart disease (IDH). Materials and Methods This was a prospective cross-sectional study involved 100 participants with primary hypertension selected by a method of simple convenient sampling. The patients were examined using ultrasonography to assess the sonographic findings of the kidneys. The renal length, corticomedullary differentiation (CMD), and renal artery diameters were assessed. Statistical Package for the Social Sciences (SPSS version 23.0) was used in data analysis. Results The length of the right kidney was 8.9850 ± 1.01 cm and 9.48 ± 0.98 cm for the left kidney. Among the hypertensive patients, the incidence of hypertension was highest in housewives (27%) and students (23%) as compared with the other groups. The sonographic findings were 18% affected with simple renal cysts, 7% poor CMD, and the majority had normal kidneys. Significant correlation was found between age and sonographic findings of kidneys (r = 0.21, P value = 0.033). Conclusion Simple renal cysts, poor CMD, and stenosis of renal arteries were most common sonographic findings in hypertension. Simple renal cystshad a significant association with hypertension.
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Affiliation(s)
- Moawia Gameraddin
- Department of Diagnostic Radiologic Technology, Faculty of Applied Medical Sciences, Taibah University, KSA
| | - Walaa Ismail Musa
- Faculty of Radiological Sciences and Medical Imaging, AlzaiemAlzhari University, Khartoum, Sudan
| | - Suzan Abdelmaboud
- Faculty of Radiological Sciences and Medical Imaging, AlzaiemAlzhari University, Khartoum, Sudan
| | - Sultan Alshoabi
- Department of Diagnostic Radiologic Technology, Faculty of Applied Medical Sciences, Taibah University, KSA
| | - Kamal Dahan Alsultan
- Department of Diagnostic Radiologic Technology, Faculty of Applied Medical Sciences, Taibah University, KSA
| | - Bushra A Abdelmalik
- Department of Diagnostic Radiology Science, College of Medical Applied Sciences, Hail University, Hail, KSA
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16
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Bhattad PB, Jain V. Renal Artery Stenosis As Etiology of Recurrent Flash Pulmonary Edema and Role of Imaging in Timely Diagnosis and Management. Cureus 2020; 12:e7609. [PMID: 32399343 PMCID: PMC7213650 DOI: 10.7759/cureus.7609] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Renal hypoperfusion from renal artery stenosis (RAS) activates the renin-angiotensin system, which in turn causes volume overload and hypertension. Atherosclerosis and fibromuscular dysplasia are the most common causes of renal artery stenosis. Recurrent flash pulmonary edema, also known as Pickering syndrome, is commonly associated with bilateral renal artery stenosis. There should be a high index of clinical suspicion for renal artery stenosis in the setting of recurrent flash pulmonary edema and severe hypertension in patients with atherosclerotic disease. Duplex ultrasonography is commonly recommended as the best initial test for the detection of renal artery stenosis. Computed tomography (CT) angiography (CTA) or magnetic resonance (MR) angiography (MRA) are useful diagnostic imaging studies for the detection of renal artery stenosis in patients where duplex ultrasonography is difficult. If duplex ultrasound, CTA, and MRA are indeterminate or pose a risk of significant renal impairment, renal angiography is useful for a definitive diagnosis of RAS. The focus of medical management for RAS relies on controlling renovascular hypertension and aggressive lifestyle modification with control of atherosclerotic disease risk factors. The restoration of renal artery patency by revascularization in the setting of RAS due to atherosclerosis may help in the management of hypertension and minimize renal dysfunction.
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Affiliation(s)
| | - Vinay Jain
- Radiology, James H. Quillen Veterans Affairs Medical Center, Johnson City, USA
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Boutari C, Georgianou E, Sachinidis A, Katsimardou A, Christou K, Piperidou A, Karagiannis A. Renovascular Hypertension: Novel Insights. Curr Hypertens Rev 2020; 16:24-29. [DOI: 10.2174/1573402115666190416153321] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 03/31/2019] [Accepted: 04/01/2019] [Indexed: 11/22/2022]
Abstract
Renovascular hypertension (RVH) remains among the most prevalent and important, but
also potentially reversible, causes of secondary hypertension. The predominant causes of renal artery
stenosis (RAS) are atherosclerotic renovascular arterial stenosis (ARAS) and renal fibromuscular
dysplasia. This condition can lead to progressive renal injury, cardiovascular complications and
‘flash pulmonary edema’. Duplex Doppler ultrasonography, computed tomographic angiography
and magnetic resonance angiography are the most commonly used diagnostic methods. There are
three therapeutic options available: medical therapy including renin-angiotensin-aldosterone system
antagonists, lipid-lowering agents, and antiplatelet therapy, percutaneous angioplasty with or without
stent placement and surgical revascularization. Three large trials failed to demonstrate the superiority
of renal artery revascularization over pharmaceutical therapy in controlling blood pressure
and preserving renal function. For this reason, today revascularization is only recommended for
patients with progressive worsening of renal function, recurrent ‘flash pulmonary edema’ and rapid
increase in antihypertensive requirement in patients with previously well-controlled hypertension.
However, more properly designed trials are needed in order to identify which patient populations
would probably benefit from renal revascularization.
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Affiliation(s)
- Chrysoula Boutari
- Second Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Hippocration Hospital, 49 Konstantinoupoleos, Thessaloniki, 54642, Greece
| | - Eleni Georgianou
- Second Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Hippocration Hospital, 49 Konstantinoupoleos, Thessaloniki, 54642, Greece
| | - Alexandros Sachinidis
- Second Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Hippocration Hospital, 49 Konstantinoupoleos, Thessaloniki, 54642, Greece
| | - Alexandra Katsimardou
- Second Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Hippocration Hospital, 49 Konstantinoupoleos, Thessaloniki, 54642, Greece
| | - Konstantinos Christou
- Second Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Hippocration Hospital, 49 Konstantinoupoleos, Thessaloniki, 54642, Greece
| | - Alexia Piperidou
- Second Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Hippocration Hospital, 49 Konstantinoupoleos, Thessaloniki, 54642, Greece
| | - Asterios Karagiannis
- Second Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Hippocration Hospital, 49 Konstantinoupoleos, Thessaloniki, 54642, Greece
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Abstract
Renovascular disease (RVD) is a major cause of secondary hypertension. Atherosclerotic renal artery stenosis is the most common type of RVD followed by fibromuscular dysplasia. It has long been recognized as the prototype of angiotensin-dependent hypertension. However, the mechanisms underlying the physiopathology of hypertensive occlusive vascular renal disease are complex and distinction between the different causes of RVD should be made. Recognition of these distinct types of RVD with different degrees of renal occlusive disease is important for management. The greatest challenge is to individualize and implement the best approach for each patient in the setting of widely different comorbidities.
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Affiliation(s)
- Sandra M Herrmann
- Division of Nephrology and Hypertension, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55902, USA.
| | - Stephen C Textor
- Division of Nephrology and Hypertension, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55902, USA
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Hasjim BJ, Fujitani RM, Chen SL, Donayre C, Kuo IJ, Raza A, Reddy U, Ichii H, Kabutey NK. Utilization of Carbon Dioxide Angiography and Percutaneous Balloon Angioplasty for Treatment of Transplant Renal Artery Stenosis. Ann Vasc Surg 2019; 65:10-16. [PMID: 31712187 DOI: 10.1016/j.avsg.2019.11.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2019] [Revised: 09/23/2019] [Accepted: 11/04/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND Transplant renal artery stenosis (TRAS) may lead to graft dysfunction and failure. Progressive deterioration of renal allograft function may be exacerbated by contrast-induced nephrotoxicity during iodine contrast administration for renovascular imaging of allografts. We present our institutional experience of endovascular management for TRAS using CO2 digital subtraction angiography (CO2-DSA) and balloon angioplasty to manage failing renal transplants. METHODS Four patients with renal allografts from March 2017-May 2018 were referred for graft dysfunction and pending renal transplant failure. Indications for referral included refractory hypertension, decreasing renal functioning, and elevated renovascular systolic velocities. RESULTS Median age of the four patients was 41.5 years (22-60 years). There were two male and female patients. Chronic hypertension and type 2 diabetes mellitus were the most common comorbidities. An average total of 75 mL of CO2 was used, supplemented with 17.4 mL of iodinated contrast. All patients had improvements in renal function following intervention with a mean decrease in systolic and diastolic blood pressure of 25.8% and 21.4%, respectively. We also observed a mean decrease of BUN by 13.6% and creatinine by 37.4%. Additionally, eGFR increased by 37.7%. All allografts survived after surgery, and only one patient required repeat angioplasty for recurrence. CONCLUSIONS CO2-DSA with balloon angioplasty can be successfully utilized to salvage deteriorating kidney allograft function in patients with TRAS.
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Affiliation(s)
- Bima J Hasjim
- Division of Vascular Surgery, Department of Surgery, University of California, Irvine, Orange, CA
| | - Roy M Fujitani
- Division of Vascular Surgery, Department of Surgery, University of California, Irvine, Orange, CA
| | - Samuel L Chen
- Division of Vascular Surgery and Endovascular Therapy, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Carlos Donayre
- Division of Vascular Surgery, Department of Surgery, University of California, Irvine, Orange, CA
| | - Isabella J Kuo
- Division of Vascular Surgery, Department of Surgery, University of California, Irvine, Orange, CA
| | - Aamir Raza
- Division of Nephrology and Hypertension, Department of Medicine, University of California, Irvine, Orange, CA
| | - Uttam Reddy
- Division of Nephrology and Hypertension, Department of Medicine, University of California, Irvine, Orange, CA
| | - Hirohito Ichii
- Division of Transplant Surgery, Department of Surgery, University of California, Irvine, Orange, CA
| | - Nii-Kabu Kabutey
- Division of Vascular Surgery, Department of Surgery, University of California, Irvine, Orange, CA.
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20
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Park HJ, Jang HN, Cho HS, Chang SH, Kim HJ. A case report of successfully treated nephrotic syndrome after renal angioplasty. BMC Nephrol 2019; 20:305. [PMID: 31387536 PMCID: PMC6685235 DOI: 10.1186/s12882-019-1503-y] [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: 11/19/2018] [Accepted: 07/29/2019] [Indexed: 11/12/2022] Open
Abstract
Background The standard treatment of renovascular hypertension accompanying renal artery stenosis (RAS) consists of angioplasty and administration of antihypertensive medication. Although nephrotic syndrome (NS) has been reported to be associated with RAS, the development of NS after revascularization of RAS is extremely rare. Case presentation A 48-year-old man presented with uncontrolled hypertension and azotemia. The right kidney was atrophic, and RAS of the left kidney was suspected based on a post-captopril DTPA scan. His blood pressure stabilized after renal angioplasty; however, he complained of edema after 1 week. NS developed and was diagnosed as focal segmental glomerulosclerosis (FSGS) based on renal biopsy. He received an angiotensin receptor blocker. Proteinuria resolved after 1 year. Conclusions FSGS rarely develops after angioplasty of renal artery stenosis. This is the first report of successful treatment of this condition using an angiotensin receptor blocker during 1-year follow-up.
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Affiliation(s)
- Hee Jung Park
- Division of Nephrology, Department of Internal Medicine, Gyeongsang National University Hospital, Jinju, South Korea
| | - Ha Nee Jang
- Division of Nephrology, Department of Internal Medicine, Gyeongsang National University Hospital, Jinju, South Korea
| | - Hyun Seop Cho
- Division of Nephrology, Department of Internal Medicine, Gyeongsang National University Hospital, Jinju, South Korea.,Department of Internal Medicine, College of Medicine, Gyeongsang National University, Jinju, South Korea.,Institute of Health Sciences, Gyeongsang National University, Jinju, South Korea
| | - Se-Ho Chang
- Division of Nephrology, Department of Internal Medicine, Gyeongsang National University Hospital, Jinju, South Korea.,Department of Internal Medicine, College of Medicine, Gyeongsang National University, Jinju, South Korea.,Institute of Health Sciences, Gyeongsang National University, Jinju, South Korea
| | - Hyun-Jung Kim
- Division of Nephrology, Department of Internal Medicine, Gyeongsang National University Hospital, Jinju, South Korea. .,Department of Internal Medicine, College of Medicine, Gyeongsang National University, Jinju, South Korea. .,Institute of Health Sciences, Gyeongsang National University, Jinju, South Korea.
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21
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Santos SND, Alcantara MLD, Freire CMV, Cantisano AL, Teodoro JAR, Porto CLL, Amaral SID, Veloso O, Albricker ACL, Petisco ACGP, Barros FS, Barros MVL, Saleh MH, Vieira MLC. Vascular Ultrasound Statement from the Department of Cardiovascular Imaging of the Brazilian Society of Cardiology - 2019. Arq Bras Cardiol 2019; 112:809-849. [PMID: 31314836 PMCID: PMC6636370 DOI: 10.5935/abc.20190106] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Affiliation(s)
| | - Monica Luiza de Alcantara
- Americas Medical City, Rio de Janeiro, RJ - Brazil.,Hospital Samaritano, Rio de Janeiro, RJ - Brazil
| | | | | | | | | | - Salomon Israel do Amaral
- Americas Medical City, Rio de Janeiro, RJ - Brazil.,Hospital Samaritano, Rio de Janeiro, RJ - Brazil
| | | | | | | | | | | | | | - Marcelo Luiz Campos Vieira
- Universidade de São Paulo (USP), São Paulo, SP - Brazil.,Hospital Israelita Albert Einstein, São Paulo, SP - Brazil.,Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da USP, São Paulo, SP - Brazil
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Restenosis Rates After Drug-Eluting Stent Treatment for Stenotic Small-Diameter Renal Arteries. Cardiovasc Intervent Radiol 2019; 42:1293-1301. [PMID: 31267151 DOI: 10.1007/s00270-019-02264-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 06/07/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE To determine primary rates in small-diameter renal arteries, including complex bifurcation lesions, treated with drug-eluting stents (DES) in patients with atherosclerotic renal artery stenosis. MATERIALS AND METHODS This is a retrospective single-institution study. A total of 37 patients with 39 stented renal arteries were included. Patient and procedural data were obtained from the electronic medical record. Survival free from restenosis was estimated using the Kaplan-Meier method with patients stratified into two groups based on renal artery diameters (≤ 3.5 mm or > 3.5 mm). Univariate Cox proportional models were used to estimate hazard ratios associated with clinical and angiographic variables. RESULTS Average renal artery diameter at time of treatment was 3.4 mm ± 0.4 mm. The median survival free from restenosis was 992 days, with 11 out of 37 (29.7%) developing an in-stent restenosis. Renal arteries < 3.5 mm in diameter had similar patency rates as renal arteries > 3.5 mm (P = 0.33). The 1-, 2-, and 5-year patency rates were 71%, 63%, and 38%, respectively. History of stroke was the only comorbidity to portend a significantly greater rate of restenosis (hazard ratio 3.77; 95%CI, 1.05-13.6; P = 0.04). Medications did not statistically alter the risk of restenosis. CONCLUSION Revascularization of renal arteries with DES achieved similar primary patency rates irrespective of renal artery diameter. Stent configuration was not associated with time to renal replacement therapy or all-cause mortality. LEVEL OF EVIDENCE Level 3, Cohort Study.
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Cooper EL, Xie Y, Nguyen H, Brewster PS, Sholl H, Sharrett M, Ren K, Chen T, Tuttle KR, Haller ST, Jamerson K, Murphy TP, D'Agostino RB, Massaro JM, Henrich W, Cooper CJ, Cutlip DE, Dworkin LD, Shapiro JI. Early Rapid Decline in Kidney Function in Medically Managed Patients With Atherosclerotic Renal Artery Stenosis. J Am Heart Assoc 2019; 8:e012366. [PMID: 31433717 PMCID: PMC6585374 DOI: 10.1161/jaha.119.012366] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Background Early rapid declines of kidney function may occur in patients with atherosclerotic renal artery stenosis with institution of medical therapy. The causes and consequences are not well understood. Methods and Results Patients enrolled in the medical therapy–only arm of the CORAL (Cardiovascular Outcomes With Renal Artery Lesions) study were assessed for a rapid decline (RD) in estimated glomerular filtration rate (eGFR), defined as a ≥30% decrease from baseline to either 3 months, 6 months, or both. In the medical therapy–only cohort, eGFR was available in 359 subjects at all time points, the subjects were followed for a median of 4.72 years, and 66 of 359 (18%) subjects experienced an early RD. Baseline log cystatin C (odds ratio, 1.78 [1.11–2.85]; P=0.02), age (odds ratio, 1.04 [1.00–1.07]; P<0.05), and Chronic Kidney Disease Epidemiology Collaboration creatinine eGFR (odds ratio, 1.86 [1.15–3.0]; P=0.01) were associated with an early RD. Despite continued medical therapy only, the RD group had an improvement in eGFR at 1 year (6.9%; P=0.04). The RD and nondecline groups were not significantly different for clinical events and all‐cause mortality (P=0.78 and P=0.76, respectively). Similarly, renal replacement therapy occurred in 1 of 66 (1.5%) of the RD patients and in 6 of 294 (2%) of the nondecline patients. The regression to the mean of improvement in eGFR at 1 year in the RD group was estimated at 5.8±7.1%. Conclusions Early rapid declines in kidney function may occur in patients with renal artery stenosis when medical therapy is initiated, and their clinical outcomes are comparable to those without such a decline, when medical therapy only is continued. See Editorial Beige
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Affiliation(s)
- Emily L. Cooper
- Department of MedicineUniversity of Toledo College of Medicine and Life SciencesToledoOH
| | - Yanmei Xie
- Department of MedicineUniversity of Toledo College of Medicine and Life SciencesToledoOH
| | - Hanh Nguyen
- Department of MedicineUniversity of Toledo College of Medicine and Life SciencesToledoOH
| | - Pamela S. Brewster
- Department of MedicineUniversity of Toledo College of Medicine and Life SciencesToledoOH
| | - Haden Sholl
- Department of MedicineUniversity of Toledo College of Medicine and Life SciencesToledoOH
| | - Megan Sharrett
- Department of MedicineUniversity of Toledo College of Medicine and Life SciencesToledoOH
| | - Kaili Ren
- Department of MedicineUniversity of Toledo College of Medicine and Life SciencesToledoOH
| | - Tian Chen
- Department of MedicineUniversity of Toledo College of Medicine and Life SciencesToledoOH
| | - Katherine R. Tuttle
- Division of NephrologyUniversity of Washington School of MedicineProvidence Sacred Heart Medical CenterSpokaneWA
| | - Steven T. Haller
- Department of MedicineUniversity of Toledo College of Medicine and Life SciencesToledoOH
| | | | - Timothy P. Murphy
- Department of Diagnostic ImagingRhode Island Hospital and Alpert Medical School of Brown UniversityProvidenceRI
| | | | - Joseph M. Massaro
- Department of BiostatisticsSchool of Public HealthBoston UniversityBostonMA
| | | | - Christopher J. Cooper
- Department of MedicineUniversity of Toledo College of Medicine and Life SciencesToledoOH
| | - Donald E. Cutlip
- Department of MedicineHarvard UniversityBeth Israel Deaconess Medical CenterBostonMA
| | - Lance D. Dworkin
- Department of MedicineUniversity of Toledo College of Medicine and Life SciencesToledoOH
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Long-term assessment of intrarenal blood flow with Doppler ultrasonography for hypertensive patients after percutaneous transluminal renal angioplasty. Hypertens Res 2019; 42:1649-1651. [PMID: 31150020 PMCID: PMC8075869 DOI: 10.1038/s41440-019-0272-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Revised: 05/02/2019] [Accepted: 05/13/2019] [Indexed: 12/02/2022]
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25
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Abstract
Approximately 33% of adults in the United States have high blood pressure; approximately 1% will present with a hypertensive emergency. Hypertension emergency is typically defined as a blood pressure great than 180/120 mmHg leading to end organ damage. However, it is important to note that an acute rise in blood pressure may also lead to end organ damage before achieving the blood pressure threshold. Therapeutic intervention should be a short-acting, easily titratable, intravenous antihypertensive medication based on the type of end-organ damage, pharmacokinetics, and comorbidities. This review focuses on presentations and treatment of hypertensive emergency.
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Cavalcante Araújo N. Does the measurement of the difference of resistive indexes in spleen and kidney might be used for characterization of intrarenal tardus parvus phenomenon in chronic kidney disease? Med Hypotheses 2019; 124:1-6. [PMID: 30798900 DOI: 10.1016/j.mehy.2019.01.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2018] [Revised: 01/10/2019] [Accepted: 01/23/2019] [Indexed: 01/20/2023]
Abstract
Doppler sonography is used as a routine test for detection of renal artery stenosis (RAS). Although increased peak systolic velocity at the site of the narrowing is a widely accepted method for assessing main renal artery stenosis, tardus parvus phenomenon detected on the downstream blood flow has been used as an alternative to direct insonation of the main artery. However, the uncertainty about the best Doppler parameter to be used for characterization of tardus parvus has yielded a variety of studies. Recently, the difference between the resistive index of the spleen and kidney (RISK) has been proposed as a potential marker of kidney damage and Doppler criterion for RAS in hypertensive patients without chronic kidney disease (CKD). The hypothesis of this study was to speculate further and propose the RISK as valuable new Doppler diagnostic criteria for the tardus parvus in CKD too. Data from 183 control patients and 135 chronic kidney disease patients (CKD) were included in the study to test the feasibility of the method and plausibility of the hypothesis. Criteria inclusion was a color Doppler ultrasound measurement of the renal (RRI) and spleen resistive index (SRI). Serum creatinine (0.83 ± 0.20 vs 3.27 ± 1.74), RRI (0.60 ± 0.06 vs 0.69 ± 0.09), SRI (0.55 ± 0.06 vs 0.58 ± 0.09), RISK (0.06 ± 0.04 vs 0.11 ± 0.08), and spleen size (94.1 ± 13.2 vs 100.8 ± 16.5) were higher in CKD patients (p < 0.05). RRI correlated with SRI in both groups; however, the coefficient of determination was different (Z = 2.29, p = 0.022). In the CKD group, RISK correlated inversely with age (r = -0.276; p = 0.001) and positively with creatinine (r = 0.509; p < 0.001). In the multivariate analysis, creatinine remained an independent predictor of the high RISK (Wald = 13.07; p < 0.001; odds ratio = 1.87; 95% confidence interval 1.33-2.62). Since extraneous factors similarly influence RRI and SRI, the SRI can be considered the correction factor that can estimate the cardiovascular burden on the RRI. Consequently, according to the suggested hypothesis, RISK helps to distinguish the tardus parvus related to RAS from tardus parvus related to systemic influences on Doppler morphology. The identification of the underlying mechanisms of tardus parvus, would help a more accurate characterization of the phenomenon and improve screening and diagnostic test for RAS in CKD patients.
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Stenosis Indicators Applied to Patient-Specific Renal Arteries without and with Stenosis. FLUIDS 2019. [DOI: 10.3390/fluids4010026] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Pulsatile flow in the abdominal aorta and the renal arteries of three patients was studied numerically. Two of the patients had renal artery stenosis. The aim of the study was to assess the use of four types of indicators for determining the risk of new stenosis after revascularization of the affected arteries. The four indicators considered include the time averaged wall shear stress (TAWSS), the oscillatory shear index (OSI), the relative reference time (RRT) and a power law model based in platelet activation modeling but applied to the endothelium, named endothelium activation indicator (EAI). The results show that the indicators can detect the existing stenosis but are less successful in the revascularized cases. The TAWSS and, more clearly, the EAI approach seem to be better in predicting the risk for stenosis relapse at the original location and close to the post-stenotic dilatation. The shortcomings of the respective indicators are discussed along with potential improvements to endothelial activation modeling and its use as an indicator for risks of restenosis.
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Abstract
Obstructive kidney disease is a common urologic diagnosis and includes kidney stones, polycystic kidney disease, and renal artery stenosis. Kidney stones are a common emergency department admission in the United States. Men are affected more than women. Polycystic kidney disease is a genetic renal disease that may not reveal symptoms until an individual reaches age 30 years. Renal artery stenosis contributes to decreased perfusion to the kidneys, which contributes to hypertension and end-stage renal disease.
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Affiliation(s)
- Sherri Stevens
- Middle Tennessee State University, MTSU Box 81, Murfreesboro, TN 37132, USA.
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Singh PK, Rajput R, Banerjee S, Garg K. Unilateral renal artery stenosis presenting as acute flaccid paralysis: a rare presentation. BMJ Case Rep 2018; 2018:bcr-2018-225889. [PMID: 30171155 DOI: 10.1136/bcr-2018-225889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Renovascular hypertension is one of the common causes of secondary hypertension. Here we report a case of patient of renal artery stenosis presenting to the emergency department as a case of acute flaccid paralysis. Renal artery stenosis has been associated with hypokalaemia, but rarely reported to be symptomatic. Initial correction of hypokalaemia leads to improvement of weakness and aetiological work up for hypokalaemia with hypertension revealed hypokalaemia due to hyperaldosteronism secondary to unilateral renal artery stenosis. The patient was managed medically with aldosterone antagonist in the anti hypertensive therapy and weakness did not recur despite withdrawal of potassium supplements. On follow-up, the patient was ambulatory with no signs of weakness, controlled blood pressure and normal potassium level.
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Affiliation(s)
- Pradyumna Kumar Singh
- Department of Endocrinology and Medicine Unit 5, Pt. B.D.Sharma PGIMS, Rohtak, Haryana, India
| | - Rajesh Rajput
- Department of Endocrinology and Medicine Unit 5, Pt. B.D.Sharma PGIMS, Rohtak, Haryana, India
| | - Saurav Banerjee
- Department of Endocrinology and Medicine Unit 5, Pt. B.D.Sharma PGIMS, Rohtak, Haryana, India
| | - Keshav Garg
- Department of Endocrinology and Medicine Unit 5, Pt. B.D.Sharma PGIMS, Rohtak, Haryana, India
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van de Velde L, Donselaar EJ, Groot Jebbink E, Boersen JT, Lajoinie GP, de Vries JPP, Zeebregts CJ, Versluis M, Reijnen MM. Partial renal coverage in endovascular aneurysm repair causes unfavorable renal flow patterns in an infrarenal aneurysm model. J Vasc Surg 2018; 67:1585-1594. [DOI: https:/doi.org/10.1016/j.jvs.2017.05.092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2023]
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Yamuna J, Chandrasekharan A, Rangasami R, Ramalakshmi S, Joseph S. Unenhanced renal magnetic resonance angiography in patients with chronic kidney disease & suspected renovascular hypertension: Can it affect patient management? Indian J Med Res 2018; 146:S22-S29. [PMID: 29578191 PMCID: PMC5890592 DOI: 10.4103/ijmr.ijmr_1613_15] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Background & objectives: Renal artery stenosis (RAS) is an important cause of severe hypertension in patients with chronic kidney disease (CKD). It is important to detect RAS early as it can reverse hypertension and stop rapid deterioration of renal function. The potential drawbacks of various imaging modalities used to detect RAS including contrast-related adverse effects associated with diagnostic angiography have led to increasing interest in unenhanced magnetic resonance (MR) renal angiography. The aim of this study was to detect and grade RAS in patients with CKD and suspected renovascular hypertension using unenhanced MR angiography (UMRA) and to identify patients with significant RAS (>70%) who would subsequently require further investigation and revascularization. Methods: Thirty five CKD patients with suspected RAS were subjected to UMRA using non-contrast MR angiography of ArTery and VEins 3D True fast imaging with steady state precession technique over a three year period. Patients with RAS >70 per cent on UMRA were subjected to digital subtraction angiography (DSA) with intervention if indicated. Results: In all, 76 renal arteries were evaluated using UMRA in 35 patients, of which 18 arteries showed stenosis and 11 were haemodynamically significant (eight patients). Seven patients (10 renal arteries) underwent DSA. Interpretation & conclusions: An association between UMRA and DSA findings was obtained in six patients (nine renal arteries), and these patients were stented. Post-procedure follow up showed good improvement in blood pressure and renal function. UMRA was found to be a useful non-invasive imaging modality to detect RAS in CKD patients. It can identify patients who require further invasive angiography and revascularization.
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Affiliation(s)
- J Yamuna
- Department of Radiology & Imaging Sciences, Sri Ramachandra Medical College & Research Institute, Sri Ramachandra University, Chennai, India
| | - Anupama Chandrasekharan
- Department of Radiology & Imaging Sciences, Sri Ramachandra Medical College & Research Institute, Sri Ramachandra University, Chennai, India
| | - Rajeswaran Rangasami
- Department of Radiology & Imaging Sciences, Sri Ramachandra Medical College & Research Institute, Sri Ramachandra University, Chennai, India
| | - S Ramalakshmi
- Department of Nephrology, Sri Ramachandra Medical College & Research Institute, Sri Ramachandra University, Chennai, India
| | - Santhosh Joseph
- Department of Neuroradiology, Sri Ramachandra Medical College & Research Institute, Sri Ramachandra University, Chennai, India
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Stavropoulos K, Imprialos KP, Athyros VG, Doumas M. Renal resistive index for renovascular hypertension: In the quest of the Holy Grail. J Clin Hypertens (Greenwich) 2018; 20:589-591. [DOI: 10.1111/jch.13221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Konstantinos Stavropoulos
- 2nd Propedeutic Department of Internal Medicine; Aristotle University of Thessaloniki; Thessaloniki Greece
| | - Konstantinos P. Imprialos
- 2nd Propedeutic Department of Internal Medicine; Aristotle University of Thessaloniki; Thessaloniki Greece
| | - Vasilios G. Athyros
- 2nd Propedeutic Department of Internal Medicine; Aristotle University of Thessaloniki; Thessaloniki Greece
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Katsiki N, Kolovou G, Perez-Martinez P, Mikhailidis DP. Dyslipidaemia in the elderly: to treat or not to treat? Expert Rev Clin Pharmacol 2018; 11:259-278. [PMID: 29303009 DOI: 10.1080/17512433.2018.1425138] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION The elderly population (i.e. aged ≥ 65 years) is increasing worldwide. Ageing is associated with a higher incidence and prevalence of cardiovascular disease (CVD). Areas covered: The prevalence of CVD risk factors including type 2 diabetes mellitus, hypertension and dyslipidaemia also increases with advancing age, contributing to the higher absolute CVD risk observed in the elderly. The present narrative review comments on the associations of dyslipidaemia with CVD as well as the effects of lifestyle measures and lipid-lowering drugs on lipids and CVD risk with a special focus on the elderly population. Individual treatment goals and therapeutic options according to current guidelines are also reviewed. Finally, we discuss special characteristics of the elderly that may influence the efficacy and safety of drug therapy and should be considered before selection of hypolipidaemic pharmacotherapy. Expert commentary: There may be a greater CVD benefit in older patients following drug therapy compared with younger ones. Treatment goals and therapeutic options should be individualized according to current guidelines. Specific characteristics that may influence the efficacy and safety of drug therapy in the elderly should be considered in relation to dyslipidaemia treatment.
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Affiliation(s)
- Niki Katsiki
- a Second Propedeutic Department of Internal Medicine, Medical School , Aristotle University of Thessaloniki, Hippocration Hospital , Thessaloniki , Greece
| | - Genovefa Kolovou
- b Cardiology Department and LDL-Apheresis Unit , Onassis Cardiac Surgery Center , Athens , Greece
| | - Pablo Perez-Martinez
- c Lipid and Atherosclerosis Unit , IMIBIC/Reina Sofia University Hospital/University of Cordoba, and CIBER Fisiopatologia Obesidad y Nutricion (CIBEROBN), Instituto de Salud Carlos III , Spain
| | - Dimitri P Mikhailidis
- d Department of Clinical Biochemistry , Royal Free Hospital Campus, University College London Medical School, University College London (UCL) , London , UK
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Partial renal coverage in endovascular aneurysm repair causes unfavorable renal flow patterns in an infrarenal aneurysm model. J Vasc Surg 2017; 67:1585-1594. [PMID: 28893490 DOI: 10.1016/j.jvs.2017.05.092] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Accepted: 05/01/2017] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To achieve an optimal sealing zone during endovascular aneurysm repair, the intended positioning of the proximal end of the endograft fabric should be as close as possible to the most caudal edge of the renal arteries. Some endografts exhibit a small offset between the radiopaque markers and the proximal fabric edge. Unintended partial renal artery coverage may thus occur. This study investigated the consequences of partial coverage on renal flow patterns and wall shear stress (WSS). METHODS In vitro models of an abdominal aortic aneurysm were used to visualize pulsatile flow using two-dimensional particle image velocimetry under physiologic resting conditions. One model served as control and two models were stented with an Endurant endograft (Medtronic Inc, Minneapolis, Minn), one without and one with partial renal artery coverage with 1.3 mm of stent fabric extending beyond the marker (16% area coverage). The magnitude and oscillation of WSS, relative residence time, and backflow in the renal artery were analyzed. RESULTS In both stented models, a region along the caudal renal artery wall presented with low and oscillating WSS, not present in the control model. A region with very low WSS (<0.1 Pa) was present in the model with partial coverage over a length of 7 mm compared with a length of 2 mm in the model without renal coverage. Average renal backflow area percentage in the renal artery incrementally increased from control (0.9%) to the stented model without (6.4%) and with renal coverage (18.8%). CONCLUSIONS In this flow model, partial renal coverage after endovascular aneurysm repair causes low and marked oscillations in WSS, potentially promoting atherosclerosis and subsequent renal artery stenosis. Awareness of the device-dependent offset between the fabric edge and the radiopaque markers is therefore important in endovascular practice.
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Young A, Crawford T, Pierre AS, Trent Magruder J, Fraser C, Conte J, Whitman G, Sciortino C. Renal ultrasound provides low utility in evaluating cardiac surgery associated acute kidney injury. J Cardiothorac Surg 2017; 12:75. [PMID: 28865484 PMCID: PMC5581929 DOI: 10.1186/s13019-017-0637-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2017] [Accepted: 08/24/2017] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Renal ultrasonography is part of the algorithm in assessing acute kidney injury (AKI). The purpose of this study was to assess the clinical utility of renal US in postoperative cardiac patients who develop AKI. METHODS We conducted a retrospective study of 90 postoperative cardiac surgery patients at a single institution from 1/19/2010 to 3/19/2016 who underwent renal US for AKI. We reviewed provider documentation to determine whether renal US changed management. We defined change as: administration of crystalloid or colloid, addition of inotropic or vasopressor, or procedural interventions on the renal system. RESULTS Mean age of study patients was 68 ± 13 years. 48/90 patients (53.3%) had pre-existing chronic kidney disease of varying severity. 48 patients (53.3%) had normal renal US with incidental findings and 31 patients (34.4%) had US evidence of medical kidney disease. 10 patients (11.1%) had limited US results due to poor visualization and 1 patient (1.1%) had mild right-sided hydronephrosis. No patients were found to have obstructive uropathy or renal artery stenosis. Clinical management was altered in only 4/90 patients (4.4%), which included 3 patients that received a fluid bolus and 1 patient that received a fluid bolus and inotropes. No vascular or urologic procedures resulted from US findings. CONCLUSION Although renal ultrasound is often utilized in the work-up of AKI, our study shows that renal US provides little benefit in managing postoperative cardiac patients. This diagnostic modality should be scrutinized rather than viewed as a universal measure in the cardiac surgery population.
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Affiliation(s)
- Allen Young
- Division of Cardiac Surgery, Johns Hopkins University School of Medicine, Sheikh Zayed Tower 1800 Orleans Street, Baltimore, MD 21287 USA
| | - Todd Crawford
- Division of Cardiac Surgery, Johns Hopkins University School of Medicine, Sheikh Zayed Tower 1800 Orleans Street, Baltimore, MD 21287 USA
| | - Alejandro Suarez Pierre
- Division of Cardiac Surgery, Johns Hopkins University School of Medicine, Sheikh Zayed Tower 1800 Orleans Street, Baltimore, MD 21287 USA
| | - J. Trent Magruder
- Division of Cardiac Surgery, Johns Hopkins University School of Medicine, Sheikh Zayed Tower 1800 Orleans Street, Baltimore, MD 21287 USA
| | - Charles Fraser
- Division of Cardiac Surgery, Johns Hopkins University School of Medicine, Sheikh Zayed Tower 1800 Orleans Street, Baltimore, MD 21287 USA
| | - John Conte
- Division of Cardiac Surgery, Johns Hopkins University School of Medicine, Sheikh Zayed Tower 1800 Orleans Street, Baltimore, MD 21287 USA
| | - Glenn Whitman
- Division of Cardiac Surgery, Johns Hopkins University School of Medicine, Sheikh Zayed Tower 1800 Orleans Street, Baltimore, MD 21287 USA
| | - Christopher Sciortino
- Division of Cardiac Surgery, University of Pittsburgh Medical Center (UPMC) Presbyterian, Suite C-700, 200 Lothrop St. Pittsburgh, Pittsburgh, PA 15213 USA
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Fabrega-Foster KE, Agarwal S, Rastegar N, Haverstock D, Agris JM, Kamel IR. Efficacy and safety of gadobutrol-enhanced MRA of the renal arteries: Results from GRAMS (Gadobutrol-enhanced renal artery MRA study), a prospective, intraindividual multicenter phase 3 blinded study. J Magn Reson Imaging 2017; 47:572-581. [PMID: 28574637 DOI: 10.1002/jmri.25774] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2017] [Accepted: 05/11/2017] [Indexed: 11/10/2022] Open
Abstract
PURPOSE To compare the performance of magnetic resonance angiography (MRA) with 1M gadobutrol, a high relaxivity macrocyclic contrast agent, to 2D time-of-flight MRA (ToF-MRA) using computed tomographic angiography (CTA) as the standard of reference. Primary objectives were evaluation for superiority of structural delineation and noninferiority for detection and exclusion of clinically significant disease. MATERIALS AND METHODS In all, 315 subjects underwent unenhanced and contrast-enhanced MRA with 1M gadobutrol (CE-MRA) and were scanned with 1.5T MRI equipped with an at least 6-element body coil. Evaluations were based on both centralized blinded read (BR) performed by six readers as well as investigator site interpretations for the 292 subjects who completed the study. Quantitative evaluations including percent stenosis and normal vessel measurements were also performed. Secondary endpoints included identification of accessory renal arteries, diagnosis of fibromuscular dysplasia (FMD), diagnostic confidence, and need for additional imaging. RESULTS A total of 292 patients suspected of renal artery disease completed the study. CE-MRA demonstrated statistically significant improvement in assessability of vascular segments compared to ToF: 95.9% vs. 77.6% (P < 0.0001). In the BR, the sensitivity and specificity of CE-MRA were noninferior to ToF-MRA (53.4% vs. 46.6% and 95.1% vs. 85.7%, respectively). There was less error in the CE-MRA stenosis measurements (0.15 mm gadobutrol vs. 0.41 mm ToF, P < 0.05). FMD was correctly diagnosed more frequently, 10% more accessory renal arteries were identified (P < 0.01), diagnostic confidence increased (P < 0.01), and fewer additional imaging studies were recommended (P < 0.01). CONCLUSION Gadobutrol-enhanced MRA of the renal arteries has superior visualization, more accurate vessel measurements, and may serve as a CTA alternative without any ionizing radiation. LEVEL OF EVIDENCE 1 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2018;47:572-581.
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Affiliation(s)
| | - Sheela Agarwal
- US Medical Affairs, Bayer HealthCare, Whippany, New Jersey, USA
| | - Neda Rastegar
- Department of Radiology Rutgers, The State University of New Jersey, Newark, NJ
| | - Daniel Haverstock
- Pharmaceutical Division, Bayer HealthCare, Whippany, New Jersey, USA
| | - Jacob M Agris
- Director of Global Medical and Clinical Affairs, Bayer HealthCare, Whippany, New Jersey, USA
| | - Ihab R Kamel
- Johns Hopkins Hospital, Department of Radiology, Baltimore, Maryland, USA
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Li LQ, Zhang J, Wang R, Li JX, Gu YQ. Establishment and evaluation of a reversible two-kidney, one-clip renovascular hypertensive rat model. Exp Ther Med 2017; 13:3291-3296. [PMID: 28587402 PMCID: PMC5450695 DOI: 10.3892/etm.2017.4386] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Accepted: 02/03/2017] [Indexed: 12/30/2022] Open
Abstract
The aim of the present study was to establish and evaluate a novel and reversible two-kidney, one-clip renovascular hypertensive rat model with a titanium vascular clip. A total of 40 male Sprague-Dawley rats were evenly and randomly divided into a sham-operated group, and 3, 7, 12 and 28D groups (namely removing the vascular clip in the renovascular hypertensive model after 3, 7, 12 and 28 days, respectively). The systolic blood pressure (SBP) and plasma renin activity (PRA) were measured, and color duplex imaging was conducted before placing the clips, as well as before and after removing them. After placing the vascular clips, SBP and PRA in the 3, 7, 12 and 28D groups were significantly increased (SBP: Sham-operated vs. 3D groups, P=0.020; 3 vs. 7D groups, P=0.008; 7 vs. 28D groups, P=0.019; 12 vs. 28D groups, P=0.039, and between other groups P<0.001. PRA: 3 vs. 7D groups, P=0.001; 7 vs. 12D groups, P=0.004; 12 vs. 28D groups, P=0.040, and between other groups, P<0.001). After removing the clips, SBP were significantly reduced in the 3 and 7D groups (P=0.023, 0.040, 0.066 and 0.314 in the 3, 7, 12 and 28D groups, respectively), but were still significantly higher than that before placing clips in the 7, 12 and 28D groups (P=0.067, P=0.005, P<0.001 and P<0.001 in the 3, 7, 12 and 28D groups, respectively). After removing the clips, PRA was significantly reduced in each group (P<0.001, P<0.001, P=0.012 and P=0.049 in 3, 7, 12 and 28D groups, respectively), but still higher than that before placing the clips (P<0.001, P=0.001, P=0.001 and P=0.003 in 3, 7, 12 and 28D groups, respectively). Vascular imaging also indicates this model has a reversible property. In conclusion, a reversible renovascular hypertension rat model is feasible, and provides a basis for research on clinical ischemic nephropathy and renal artery revascularization.
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Affiliation(s)
- Li-Qiang Li
- Department of Vascular Surgery, Xuan Wu Hospital and Institute of Vascular Surgery, Capital Medical University, Beijing 100053, P.R. China
| | - Jian Zhang
- Department of Vascular Surgery, Xuan Wu Hospital and Institute of Vascular Surgery, Capital Medical University, Beijing 100053, P.R. China
| | - Rong Wang
- Central Laboratory, Xuan Wu Hospital, Capital Medical University, Beijing 100053, P.R. China
| | - Jian-Xin Li
- Department of Vascular Surgery, Xuan Wu Hospital and Institute of Vascular Surgery, Capital Medical University, Beijing 100053, P.R. China
| | - Yong-Quan Gu
- Department of Vascular Surgery, Xuan Wu Hospital and Institute of Vascular Surgery, Capital Medical University, Beijing 100053, P.R. China
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Wang Y, Dinh TN, Nield A, Krishna SM, Denton K, Golledge J. Renal Denervation Promotes Atherosclerosis in Hypertensive Apolipoprotein E-Deficient Mice Infused with Angiotensin II. Front Physiol 2017; 8:215. [PMID: 28450836 PMCID: PMC5390019 DOI: 10.3389/fphys.2017.00215] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Accepted: 03/24/2017] [Indexed: 11/13/2022] Open
Abstract
Objective: To determine the effect of renal denervation (RDN) on the severity of atherosclerosis and aortic aneurysm in hypertensive mice. Methods: Hypertension, atherosclerosis and aortic aneurysm were induced by subcutaneous infusion of angiotensin II (1 μg/kg/min) for 28 days in apolipoprotein E-deficient mice. RDN was conducted using combined surgical and local chemical denervation. The norepinephrine concentration in the kidney was measured by high-performance liquid chromatography. Blood pressure was measured by the tail-cuff method. Atherosclerosis was assessed by Sudan IV staining of the aortic arch. The aortic diameter was measured by the morphometric method. The mRNA expression of genes associated with atherosclerosis and aortic aneurysm were analyzed by quantitative PCR. Results: RDN decreased the median norepinephrine content in the kidney by 93.4% (n = 5-7, P = 0.003) 5 days after the procedure, indicating that the RDN procedure was successful. RDN decreased systolic blood pressure in apolipoprotein E-deficient mice. Mice that had RDN had more severe aortic arch atherosclerosis (median percentage of Sudan IV positive area: 13.2% in control mice, n = 12, and 25.4% in mice having RDN, n = 12, P = 0.028). The severity of the atherosclerosis was negatively correlated with the renal norepinephrine content (spearman r = -0.6557, P = 0.005). RDN did not affect the size of aortic aneurysms formed or the incidence of aortic rupture in mice receiving angiotensin II. RDN significantly increased the aortic mRNA expression of matrix metalloproteinase-2 (MMP-2). Conclusion: RDN promoted atherosclerosis in apolipoprotein E-deficient mice infused with angiotensin II associated with upregulation of MMP-2. The higher MMP-2 expression could be the results of the greater amount of atheroma in the RDN mice. The findings suggest further research is needed to assess potentially deleterious effects of RDN in patients.
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Affiliation(s)
- Yutang Wang
- School of Applied and Biomedical Science, Federation University AustraliaBallarat, VIC, Australia.,The Vascular Biology Unit, Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook UniversityTownsville, QLD, Australia
| | - Tam N Dinh
- School of Applied and Biomedical Science, Federation University AustraliaBallarat, VIC, Australia.,The Vascular Biology Unit, Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook UniversityTownsville, QLD, Australia
| | - Alexander Nield
- School of Applied and Biomedical Science, Federation University AustraliaBallarat, VIC, Australia
| | - Smriti M Krishna
- The Vascular Biology Unit, Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook UniversityTownsville, QLD, Australia
| | - Kate Denton
- Cardiovascular and Renal Physiology, Department of Physiology, Monash UniversityClayton, VIC, Australia
| | - Jonathan Golledge
- The Vascular Biology Unit, Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook UniversityTownsville, QLD, Australia.,Department of Vascular and Endovascular Surgery, The Townsville HospitalTownsville, QLD, Australia
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Reducing Iodine Contrast Volume in CT Angiography of the Abdominal Aorta Using Integrated Tube Potential Selection and Weight-Based Method Without Compromising Image Quality. AJR Am J Roentgenol 2017; 208:552-563. [DOI: 10.2214/ajr.16.16613] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Zachrisson K, Herlitz H, Lönn L, Falkenberg M, Eklöf H. Duplex ultrasound for identifying renal artery stenosis: direct criteria re-evaluated. Acta Radiol 2017; 58:176-182. [PMID: 27069093 DOI: 10.1177/0284185116641345] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Background Renal artery duplex ultrasound (RADUS) is an established method for diagnosis of renal artery stenosis (RAS), but there is no consensus regarding optimal RADUS criteria. Purpose To define optimal cutoff values for RADUS parameters when screening for RAS using intra-arterial trans-stenotic pressure gradient measurement (PGM) as reference. Material and Methods The renal arteries of 58 consecutive patients evaluated for renovascular hypertension were examined by RADUS and PGM. Conclusive measurements with both methods were obtained in 76 arteries. Hemodynamically significant RAS was defined as PGM ≥15 mmHg and was found in 43 of the 76 arteries. RADUS parameters included renal artery peak systolic velocity (PSV) and the renal-aortic ratio (RAR) of flow velocities. Receiver operating characteristic curves (ROCs) and Youden's index were used to calculate optimal RADUS criteria for RAS. Results When traditional RADUS criteria for RAS were used, with a combination of PSV ≥180 cm/s and RAR ≥3.5, the sensitivity was 62% and the specificity was 91%. When RADUS criteria were optimized for sensitivity, then RAR ≥2.6 alone resulted in a sensitivity of 89% and a specificity of 69%. Conclusion The RAR ≥2.6 is a more sensitive criterion than traditional RADUS criteria when screening patients with clinical suspicion of RAS.
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Affiliation(s)
- Karin Zachrisson
- Department of Radiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Hans Herlitz
- Department of Molecular and Clinical Medicine, Nephrology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Lars Lönn
- Department of Radiology, Rigshospitalet, University of Copenhagen, Denmark
- Department of Vascular Surgery, Rigshospitalet, University of Copenhagen, Denmark
| | - Mårten Falkenberg
- Department of Radiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Hampus Eklöf
- Department of Surgical Sciences, Section of Radiology, Uppsala University, Uppsala, Sweden
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Renal Artery Stenosis After Abdominal Aortic Aneurysm Interventional Treatment in a Patient With Systemic Atherosclerosis. Am J Ther 2016; 23:e1922-e1924. [PMID: 27831942 DOI: 10.1097/mjt.0000000000000041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Franchi F, Zhu XY, Witt TA, Lerman LO, Rodriguez-Porcel M. Intravascular Delivery of Biologics to the Rat Kidney. J Vis Exp 2016. [PMID: 27685329 DOI: 10.3791/54418] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
The renal microvascular compartment plays an important role in the progression of kidney disease and hypertension, leading to the development of End Stage Renal Disease with high risk of death for cardiovascular events. Moreover, recent clinical studies have shown that renovascular structure and function may have a great impact on functional renal recovery after surgery. Here, we describe a protocol for the delivery of drugs into the renal artery of rats. This procedure offers significant advantages over the frequently used systemic administration as it may allow a more localized therapeutic effect. In addition, the use of rodents in pharmacodynamic analysis of preclinical studies may be cost effective, paving the way for the design of translational experiments in larger animal models. Using this technique, infusion of rat recombinant Vascular Endothelial Growth Factor (VEGF) protein in rats has induced activation of VEGF signaling as shown by increased expression of FLK1, pAKT/AKT, pERK/ERK. In summary, we established a protocol for the intrarenal delivery of drugs in rats, which is simple and highly reproducible.
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Affiliation(s)
- Federico Franchi
- Divisions of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic
| | - Xiang Yang Zhu
- Divisions of Nephrology and Hypertension, Department of Internal Medicine, Mayo Clinic
| | - Tyra A Witt
- Divisions of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic
| | - Lilach O Lerman
- Divisions of Nephrology and Hypertension, Department of Internal Medicine, Mayo Clinic
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Treatment of In-Stent Restenosis in Patients with Renal Artery Stenosis. J Vasc Interv Radiol 2016; 27:1657-1662. [PMID: 27503035 DOI: 10.1016/j.jvir.2016.05.041] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Revised: 05/28/2016] [Accepted: 05/29/2016] [Indexed: 11/22/2022] Open
Abstract
PURPOSE To determine clinical outcomes of patients treated for renal artery in-stent restenosis (ISR) with atherosclerotic renal artery stenosis. MATERIALS AND METHODS A retrospective review was performed of the clinical data of all patients who underwent renal artery stent placement for atherosclerotic renal artery stenosis from 1996 to 2009. Medical records of patients were reviewed for relevant clinical history, including blood pressure, antihypertensive medications, and renal function data before and after an intervention. In 1,052 patients, 1,090 renal artery stent placements were performed. Of these, 101 stents in 79 patients developed ISR, which was treated with either percutaneous transluminal angioplasty (PTA) or repeat stent placement. Procedural details, including modality of intervention, stent diameter, and time to restenosis, were recorded. Hypertensive agent and use of statins were recorded. Univariate analysis was performed to identify risk factors associated with restenosis after treatment of ISR. RESULTS Patients treated with repeat stent placement were 6.89 times more likely to lose patency after treatment than patients treated with PTA (P < .01). No additional clinical or procedural factor, including smoking history; presence of cardiac, renal, or metabolic disease; use of statin at time of ISR treatment; or diameter of treatment (stent or PTA), had a significant association with duration of stent or angioplasty patency. CONCLUSIONS Treatment of renal artery ISR with PTA among patients with atherosclerotic renal artery stenosis has a lower rate of subsequent ISR compared with repeat stent placement.
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Peralta P, Cholankeril M, Goldberg D, Koneru J, Shamoon F. Renal Artery Stenosis in a Young Female without Fibromuscular Dysplasia with Literature Review. CLINICAL MEDICINE INSIGHTS-CARDIOLOGY 2016; 10:99-102. [PMID: 27398034 PMCID: PMC4927107 DOI: 10.4137/cmc.s38172] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Revised: 03/31/2016] [Accepted: 04/03/2016] [Indexed: 11/16/2022]
Abstract
Renal artery stenosis (RAS) is rare in young patients without fibromuscular dysplasia (FMD). RAS is primarily classified as having two major etiologies, namely, atherosclerosis and FMD, with 90% and 10%, respectively. We report a case of a female in her mid 20s who developed hypertension due to RAS with no evidence of FMD or underlying renal dysfunction and underwent successful angioplasty and stenting.
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Affiliation(s)
- Paloma Peralta
- Seton Hall Internal Medicine Residency Program, Trinitas Regional Medical Center, Elizabeth, NJ, USA
| | - Matthew Cholankeril
- New York Medical College Cardiology Fellowship Program, St. Joseph's Medical Center, Paterson, NJ, USA
| | - Daniel Goldberg
- New York Medical College Cardiology Fellowship Program, St. Joseph's Medical Center, Paterson, NJ, USA
| | - Jayanth Koneru
- New York Medical College Cardiology Fellowship Program, St. Joseph's Medical Center, Paterson, NJ, USA
| | - Fayez Shamoon
- New York Medical College Cardiology Fellowship Program, St. Joseph's Medical Center, Paterson, NJ, USA
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Abstract
Renal artery stenosis is a potentially reversible cause of hypertension, and transcatheter techniques are essential to its treatment. Angioplasty remains a first-line treatment for stenosis secondary to fibromuscular dysplasia. Renal artery stenting is commonly used in atherosclerotic renal artery stenosis, although recent trials have cast doubts upon its efficacy. Renal denervation is a promising procedure for the treatment of resistant hypertension, and in the future, its indications may expand.
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Affiliation(s)
- Aaron Smith
- Department of Radiology, Section of Interventional Radiology, University of California, San Diego, CA
| | - Ron C Gaba
- Department of Radiology, Division of Interventional Radiology, University of Illinois Hospital & Health Sciences System, Chicago, IL
| | - James T Bui
- Department of Radiology, Division of Interventional Radiology, University of Illinois Hospital & Health Sciences System, Chicago, IL
| | - Jeet Minocha
- Department of Radiology, Section of Interventional Radiology, University of California, San Diego, CA.
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Lougheed N, Jaskolka J, Beecroft R, Menezes R. Determination of the Best Parameter for Defining the Hemodynamic Significance of an Iliac Artery Stenosis Detected on Computed Tomography Angiography. Can Assoc Radiol J 2016; 67:298-303. [PMID: 27240435 DOI: 10.1016/j.carj.2015.09.005] [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: 12/30/2014] [Revised: 08/23/2015] [Accepted: 09/09/2015] [Indexed: 11/25/2022] Open
Abstract
PURPOSE The purpose of this study was to determine the best parameter, derived from computed tomography angiography (CTA) for accurate prediction of a hemodynamically significant stenosis of the common or external iliac artery. METHODS A retrospective keyword search was performed on the Radiology Information System at our tertiary academic medical centre. Reports from January 2008 to September 2013 were searched using the keywords iliac, stenosis, and pressure. Patients who had both and CTA and a pelvic angiogram with pressure measurements obtained across a potential stenosis were selected. Using 3D postprocessing software (TeraRecon, Foster City, CA), the CTAs were analysed for the following parameters of each lesion: minimum diameter of stenosis, minimum cross-sectional area of stenosis, percent narrowing of vessel diameter, and percent reduction in vessel area. The percent stenosis was calculated in reference to the outer diameter at the point of maximal narrowing and also in reference to a normal segment of vessel more distal to the stenosis. These parameters were then compared with the measured pressure gradient using receiver-operating characteristic analysis and the Mann-Whitney U test to determine which best predicted a significant stenosis, defined as a greater than 10% drop in systolic pressure across a lesion. RESULTS One hundred and two stenoses in 83 patients (26 women, 57 men; 47-88 years old) were identified. Mean diameter of the stenosis was 2.8 mm for significant stenosis compared to 3.8 mm in nonsignificant stenoses (P = .005). Mean minimum area for significant stenoses was 11.8 mm(2) compared to 17.22 mm(2) for nonsignificant stenoses (P = .032) No other variables showed a significant difference between significant and nonsignificant stenoses. A minimum diameter of ≤4.0 mm at the level of a stenosis is 92% sensitive and 48% specific for predicting a hemodynamically significant iliac artery stenosis, with a positive predictive value of 88%. CONCLUSIONS A simple measurement of the minimum diameter of an iliac artery at the level of stenosis is the best predictor of the hemodynamic significance of a stenosis in the common or external iliac artery.
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Affiliation(s)
- Nick Lougheed
- Joint Department of Medical Imaging, University Health Network, Toronto General Hospital, Toronto, Ontario, Canada
| | - Jeff Jaskolka
- Joint Department of Medical Imaging, University Health Network, Toronto General Hospital, Toronto, Ontario, Canada.
| | - Rob Beecroft
- Joint Department of Medical Imaging, University Health Network, Toronto General Hospital, Toronto, Ontario, Canada
| | - Ravi Menezes
- Joint Department of Medical Imaging, University Health Network, Toronto General Hospital, Toronto, Ontario, Canada
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Brouwers JJ, van Wissen RC, Veger HT, Rotmans JI, Mertens B, Visser MJ. The use of intrarenal Doppler ultrasonography as predictor for positive outcome after renal artery revascularization. Vascular 2016; 25:63-73. [PMID: 27118604 DOI: 10.1177/1708538116644871] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Whether patients with renal artery stenosis should undergo therapeutic revascularization is controversial. In this retrospective study, we evaluated prognostic intrarenal Doppler ultrasound parameters that might have a predictive value for a beneficial response after renal revascularization. From January 2003 until December 2012, all renovascular interventions for renal artery stenosis were analyzed. The resistive index and the maximal systolic acceleration were determined by Doppler ultrasonography prior to intervention. Thirty-two patients who underwent a renal revascularization procedure were included: 13 combined positive responders and 19 combined non-responders. The combined positive responders had a significant lower resistive index than the combined non-responders (0.5 vs. 0.6, P = 0.001) and a significant lower maximal systolic acceleration (1.0 vs. 3.8, P = 0.001) before revascularization. A prediction model (RI ≤ 0.5 and ACCmax ≤ 1.3 m/s2) was formulated to identify a subgroup that benefits from renal revascularization. This model has an expected sensitivity of 69% and specificity of 89% for improvement in renal function and/or blood pressure after revascularization. The non-invasive intrarenal Doppler ultrasound parameters resistive index and maximal systolic acceleration can be used as tools to predict improvement in renal function and/or blood pressure after revascularization of renal artery stenosis. The clinical value of this prediction model should be evaluated in a prospective trial.
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Affiliation(s)
- Jeroen Jwm Brouwers
- 1 Department of Vascular Surgery, Leiden University Medical Center (LUMC), Leiden, the Netherlands
| | - Rob C van Wissen
- 1 Department of Vascular Surgery, Leiden University Medical Center (LUMC), Leiden, the Netherlands
| | - Hugo Tc Veger
- 2 Department of Surgery, Zuyderland Medical Center, Heerlen, the Netherlands
| | - Joris I Rotmans
- 3 Department of Nephrology, Leiden University Medical Center (LUMC), Leiden, the Netherlands
| | - Bart Mertens
- 4 Department of Medical Statistics and Bioinformatics, Leiden University Medical Center (LUMC), Leiden, the Netherlands
| | - Michel Jt Visser
- 1 Department of Vascular Surgery, Leiden University Medical Center (LUMC), Leiden, the Netherlands
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Eid M, De Cecco CN, Schoepf UJ, Mangold S, Tesche C, Varga-Szemes A, Suranyi P, Stalcup S, Ball BD, Caruso D. The Role of MRI and CT in the Diagnosis of Atherosclerosis in an Aging Population. CURRENT RADIOLOGY REPORTS 2016. [DOI: 10.1007/s40134-016-0141-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Javadzadegan A, Simmons A, Barber T. Spiral blood flow in aorta-renal bifurcation models. Comput Methods Biomech Biomed Engin 2015; 19:964-76. [PMID: 26414530 DOI: 10.1080/10255842.2015.1082552] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The presence of a spiral arterial blood flow pattern in humans has been widely accepted. It is believed that this spiral component of the blood flow alters arterial haemodynamics in both positive and negative ways. The purpose of this study was to determine the effect of spiral flow on haemodynamic changes in aorta-renal bifurcations. In this regard, a computational fluid dynamics analysis of pulsatile blood flow was performed in two idealised models of aorta-renal bifurcations with and without flow diverter. The results show that the spirality effect causes a substantial variation in blood velocity distribution, while causing only slight changes in fluid shear stress patterns. The dominant observed effect of spiral flow is on turbulent kinetic energy and flow recirculation zones. As spiral flow intensity increases, the rate of turbulent kinetic energy production decreases, reducing the region of potential damage to red blood cells and endothelial cells. Furthermore, the recirculation zones which form on the cranial sides of the aorta and renal artery shrink in size in the presence of spirality effect; this may lower the rate of atherosclerosis development and progression in the aorta-renal bifurcation. These results indicate that the spiral nature of blood flow has atheroprotective effects in renal arteries and should be taken into consideration in analyses of the aorta and renal arteries.
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Affiliation(s)
| | - Anne Simmons
- b School of Mechanical and Manufacturing Engineering , The University of New South Wales , Sydney , Australia
| | - Tracie Barber
- b School of Mechanical and Manufacturing Engineering , The University of New South Wales , Sydney , Australia
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