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Diao YP, Wu ZY, Lu CR, Chen ZG, Li YJ. Retrograde Recanalization for Proximal Occlusion of the Right Renal Artery through a Compensated Collateral Artery in a 10-year-old Patient. Ann Vasc Surg 2021; 78:379.e1-379.e5. [PMID: 34481882 DOI: 10.1016/j.avsg.2021.06.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 06/21/2021] [Accepted: 06/24/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND To describe a retrograde recanalization for the proximal occluded lesion in right renal artery (RRA) in young patient with fibromuscular dysplasia (FMD). METHODS A 10-year-old girl presented to our hospital with proximal RRA occlusion and refractory hypertension though she took anti-hypertension medicines. Her renin and aldosterone were beyond the normal level in both base state and excited state. Her glomerular filtration rate at right kidney was only 18.4 ml/min. Angiography revealed proximal RRA occlusion and a compensated collateral artery (CCA) from the infrarenal aorta to the RRA. She was thus diagnosed with focal FMD. A retrograde recanalization was performed through this CCA. RESULTS Angioplasty and stenting were successfully performed to treat the proximal RRA occlusion. Postoperatively, the glomerular filtration rate in the right kidney improved. One-year follow-up revealed that, the blood pressure maintained at normal range without any antihypertensive agents. No other discomfort was complained. CONCLUSIONS It is feasible to establish a working pathway with patient's compensated collateral artery to treat the renal artery occlusion.
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Affiliation(s)
- Yong-Peng Diao
- Department of Vascular Surgery, Beijing Hospital, National Centre of Gerontology, Institute of Geriatric Medicine, Chines Academy of Medical Science and Peking Union Medical College, Beijing, P.R. China
| | - Zhi-Yuan Wu
- Department of Vascular Surgery, Beijing Hospital, National Centre of Gerontology, Institute of Geriatric Medicine, Chines Academy of Medical Science and Peking Union Medical College, Beijing, P.R. China
| | - Cheng-Ran Lu
- Department of Vascular Surgery, Beijing Hospital, National Centre of Gerontology, Institute of Geriatric Medicine, Chines Academy of Medical Science and Peking Union Medical College, Beijing, P.R. China
| | - Zuo-Guan Chen
- Department of Vascular Surgery, Beijing Hospital, National Centre of Gerontology, Institute of Geriatric Medicine, Chines Academy of Medical Science and Peking Union Medical College, Beijing, P.R. China
| | - Yong-Jun Li
- Department of Vascular Surgery, Beijing Hospital, National Centre of Gerontology, Institute of Geriatric Medicine, Chines Academy of Medical Science and Peking Union Medical College, Beijing, P.R. China.
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Farahani RA, Afarideh M, Zhu XY, Tang H, Jordan KL, Saadiq IM, Ferguson CM, Lerman A, Textor SC, Lerman LO, Eirin A. Percutaneous transluminal renal angioplasty attenuates poststenotic kidney mitochondrial damage in pigs with renal artery stenosis and metabolic syndrome. J Cell Physiol 2021; 236:4036-4049. [PMID: 33151557 PMCID: PMC7920930 DOI: 10.1002/jcp.30146] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 10/09/2020] [Accepted: 10/26/2020] [Indexed: 02/06/2023]
Abstract
Percutaneous transluminal renal angioplasty (PTRA) has been used to treat renovascular disease (RVD), a chronic condition characterized by renal ischemia and metabolic abnormalities. Mitochondrial injury has been implicated as a central pathogenic mechanism in RVD, but whether it can be reversed by PTRA remains uncertain. We hypothesized that PTRA attenuates mitochondrial damage, renal injury, and dysfunction in pigs with coexisting renal artery stenosis (RAS) and metabolic syndrome (MetS). Four groups of pigs (n = 6 each) were studied after 16 weeks of diet-induced MetS and RAS (MetS + RAS), MetS + RAS treated 4 weeks earlier with PTRA, and Lean and MetS Sham controls. Single-kidney renal blood flow (RBF) and glomerular filtration rate (GFR) were assessed in vivo with multidetector computed tomography, and renal tubular mitochondrial structure and function and renal injury ex vivo. PTRA successfully restored renal artery patency, but mean arterial pressure remained unchanged. Stenotic kidney RBF and GFR, which fell in MetS + RAS compared to MetS, rose after PTRA. PTRA attenuated MetS + RAS-induced mitochondrial structural abnormalities in tubular cells and peritubular capillary endothelial cells, decreased mitochondrial H2 02 production, and increased renal cytochrome-c oxidase-IV activity and ATP production. PTRA also improved cortical microvascular and peritubular capillary density and ameliorated tubular injury and tubulointerstitial fibrosis in the poststenotic kidney. Importantly, renal mitochondrial damage correlated with poststenotic injury and dysfunction. Renal revascularization attenuated mitochondrial injury and improved renal hemodynamics and function in swine poststenotic kidneys. This study suggests a novel mechanism by which PTRA might be relatively effective in ameliorating mitochondrial damage and improving renal function in coexisting MetS and RAS.
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Affiliation(s)
- Rahele A. Farahani
- Department of Internal Medicine, Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN
| | - Mohsen Afarideh
- Department of Internal Medicine, Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN
| | - Xiang-Yang Zhu
- Department of Internal Medicine, Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN
| | - Hui Tang
- Department of Internal Medicine, Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN
| | - Kyra L. Jordan
- Department of Internal Medicine, Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN
| | - Ishran M. Saadiq
- Department of Internal Medicine, Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN
| | - Christopher M. Ferguson
- Department of Internal Medicine, Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN
| | - Amir Lerman
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| | - Stephen C. Textor
- Department of Internal Medicine, Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN
| | - Lilach O. Lerman
- Department of Internal Medicine, Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN
| | - Alfonso Eirin
- Department of Internal Medicine, Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN
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Augustin AM, Welsch S, Bley TA, Lopau K, Kickuth R. Color-coded summation images in the evaluation of renal artery stenosis before and after percutaneous transluminal angioplasty. BMC Med Imaging 2021; 21:21. [PMID: 33568089 PMCID: PMC7874657 DOI: 10.1186/s12880-020-00540-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Accepted: 12/20/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Endovascular therapy is the gold standard in patients with hemodynamic relevant renal artery stenosis (RAS) resistant to medical therapy. The severity grading of the stenosis as well as the result assessment after endovascular approach is predominantly based on visible estimations of the anatomic appearance. We aim to investigate the application of color-coded DSA parameters to gain hemodynamic information during endovascular renal artery interventions and for the assessment of the procedures´ technical success. METHODS We retrospectively evaluated 32 patients who underwent endovascular renal artery revascularization and applied color-coded summation imaging on selected monochromatic DSA images. The differences in time to peak (dTTP) of contrast enhancement in predefined anatomical measuring points were analyzed. Furthermore, differences in systolic blood pressure values (SBP) and serum creatinine were obtained. The value of underlying diabetes mellitus as a predictor for clinical outcome was assessed. Correlation analysis between the patients´ gender as well as the presence of diabetes mellitus and dTTP was performed. RESULTS Endovascular revascularization resulted in statistically significant improvement in 4/7 regions of interest. Highly significant improvement of perfusion in terms of shortened TTP values could be found at the segmental artery level and in the intrastenotical segment (p < 0.001), significant improvement prestenotical and in the apical renal parenchyma (p < 0.05). In the other anatomic regions, differences revealed not to be significant. Differences between SBP and serum creatinine levels before and after the procedure were significant (p = 0.004 and 0.0004). Patients´ gender as well as the presence of diabetes mellitus did not reveal to be predictors for the clinical success of the procedure. Furthermore, diabetes and gender did not show relevant correlation with dTTP in the parenchymal measuring points. CONCLUSIONS The supplementary use of color-coding DSA and the data gained from parametric images may provide helpful information in the evaluation of the procedures´ technical success. The segmental artery might be a particularly suitable vascular territory for analyzing differences in blood flow characteristics. Further studies with larger cohorts are needed to further confirm the diagnostic value of this technique.
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Affiliation(s)
- Anne Marie Augustin
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Würzburg, Germany.
| | - Stefan Welsch
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Würzburg, Germany
| | - Thorsten Alexander Bley
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Würzburg, Germany
| | - Kai Lopau
- Department of Internal Medicine, Division of Nephrology, University Hospital Würzburg, Würzburg, Germany
| | - Ralph Kickuth
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Würzburg, Germany
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Prince M, Tafur JD, White CJ. When and How Should We Revascularize Patients With Atherosclerotic Renal Artery Stenosis? JACC Cardiovasc Interv 2020; 12:505-517. [PMID: 30898248 DOI: 10.1016/j.jcin.2018.10.023] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Revised: 09/19/2018] [Accepted: 10/01/2018] [Indexed: 01/21/2023]
Abstract
Atherosclerotic renal artery stenosis is the leading cause of secondary hypertension and may lead to resistant (refractory) hypertension, progressive decline in renal function, and cardiac destabilization syndromes (pulmonary edema, recurrent heart failure, or acute coronary syndromes) despite guideline-directed medical therapy. Although randomized controlled trials comparing medical therapy with medical therapy and renal artery stenting have failed to show a benefit for renal artery stenting, according to comparative effectiveness reviews by the Agency for Healthcare Research and Quality, the trials may not have enrolled patients with the most severe atherosclerotic renal artery stenosis, who would be more likely to benefit from renal stenting. Because of limitations of conventional angiography, it is critical that the hemodynamic severity of moderately severe (50% to 70%) atherosclerotic renal artery stenosis lesions be confirmed on hemodynamic measurement. The authors review techniques to optimize patient selection, to minimize procedural complications, and to facilitate durable patency of renal stenting. The authors also review the current American College of Cardiology and American Heart Association guidelines and the Society for Cardiovascular Angiography and Interventions appropriate use criteria as they relate to renal stenting.
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Affiliation(s)
- Marloe Prince
- Department of Cardiology at Ochsner Clinic Foundation, New Orleans, Louisiana.
| | - Jose D Tafur
- Department of Cardiology at Ochsner Clinic Foundation, New Orleans, Louisiana
| | - Christopher J White
- Department of Cardiology at Ochsner Clinic Foundation, New Orleans, Louisiana
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Zhang S, Breidenbach JD, Khalaf FK, Dube PR, Mohammed CJ, Lad A, Stepkowski S, Hinds TD, Kumarasamy S, Kleinhenz A, Tian J, Malhotra D, Kennedy DJ, Cooper CJ, Haller ST. Renal Fibrosis Is Significantly Attenuated Following Targeted Disruption of Cd40 in Experimental Renal Ischemia. J Am Heart Assoc 2020; 9:e014072. [PMID: 32200719 PMCID: PMC7428653 DOI: 10.1161/jaha.119.014072] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Renal artery stenosis is a common cause of renal ischemia, contributing to the development of chronic kidney disease. To investigate the role of local CD40 expression in renal artery stenosis, Goldblatt 2‐kidney 1‐clip surgery was performed on hypertensive Dahl salt‐sensitive rats (S rats) and genetically modified S rats in which CD40 function is abolished (Cd40mutant). Methods and Results Four weeks following the 2‐kidney 1‐clip procedure, Cd40mutant rats demonstrated significantly reduced blood pressure and renal fibrosis in the ischemic kidneys compared with S rat controls. Similarly, disruption of Cd40 resulted in reduced 24‐hour urinary protein excretion in Cd40mutant rats versus S rat controls (46.2±1.9 versus 118.4±5.3 mg/24 h; P<0.01), as well as protection from oxidative stress, as indicated by increased paraoxonase activity in Cd40mutant rats versus S rat controls (P<0.01). Ischemic kidneys from Cd40mutant rats demonstrated a significant decrease in gene expression of the profibrotic mediator, plasminogen activator inhibitor‐1 (P<0.05), and the proinflammatory mediators, C‐C motif chemokine ligand 19 (P<0.01), C‐X‐C Motif Chemokine Ligand 9 (P<0.01), and interleukin‐6 receptor (P<0.001), compared with S rat ischemic kidneys, as assessed by quantitative PCR assay. Reciprocal renal transplantation documented that CD40 exclusively expressed in the kidney contributes to ischemia‐induced renal fibrosis. Furthermore, human CD40‐knockout proximal tubule epithelial cells suggested that suppression of CD40 signaling significantly inhibited expression of proinflammatory and ‐fibrotic genes. Conclusions Taken together, our data suggest that activation of CD40 induces a significant proinflammatory and ‐fibrotic response and represents an attractive therapeutic target for treatment of ischemic renal disease.
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Affiliation(s)
- Shungang Zhang
- Department of MedicineUniversity of Toledo College of Medicine and Life SciencesToledoOH
| | - Joshua D. Breidenbach
- Department of Medical Microbiology and ImmunologyUniversity of Toledo College of Medicine and Life SciencesToledoOH
| | - Fatimah K. Khalaf
- Department of MedicineUniversity of Toledo College of Medicine and Life SciencesToledoOH
| | - Prabhatchandra R. Dube
- Department of MedicineUniversity of Toledo College of Medicine and Life SciencesToledoOH
| | - Chrysan J. Mohammed
- Department of MedicineUniversity of Toledo College of Medicine and Life SciencesToledoOH
| | - Apurva Lad
- Department of Medical Microbiology and ImmunologyUniversity of Toledo College of Medicine and Life SciencesToledoOH
| | - Stanislaw Stepkowski
- Department of Medical Microbiology and ImmunologyUniversity of Toledo College of Medicine and Life SciencesToledoOH
| | - Terry D. Hinds
- Department of Physiology and PharmacologyUniversity of Toledo College of Medicine and Life SciencesToledoOH
| | - Sivarajan Kumarasamy
- Department of Physiology and PharmacologyUniversity of Toledo College of Medicine and Life SciencesToledoOH
| | - Andrew Kleinhenz
- Department of MedicineUniversity of Toledo College of Medicine and Life SciencesToledoOH
| | - Jiang Tian
- Department of MedicineUniversity of Toledo College of Medicine and Life SciencesToledoOH
| | - Deepak Malhotra
- Department of MedicineUniversity of Toledo College of Medicine and Life SciencesToledoOH
| | - David J. Kennedy
- Department of MedicineUniversity of Toledo College of Medicine and Life SciencesToledoOH
| | - Christopher J. Cooper
- Department of MedicineUniversity of Toledo College of Medicine and Life SciencesToledoOH
| | - Steven T. Haller
- Department of MedicineUniversity of Toledo College of Medicine and Life SciencesToledoOH
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Abstract
OBJECTIVE The Cardiovascular Outcomes in Renal Atherosclerotic Lesions (CORAL) trial, a multicenter randomized controlled trial, failed to demonstrate a benefit of renal artery stenting (RAS) over medical therapy in patients with renal artery stenosis and hypertension. However, there are patients for whom RAS is a consideration because of failure of medical therapy. Unfortunately, selection of patients for RAS is complicated by a lack of validated predictors of blood pressure (BP) response. A previous single-center study identified three preoperative markers of BP response to RAS: requirement for four or more antihypertensive medications, preoperative diastolic BP >90 mm Hg, and preoperative clonidine use. To date, these markers of outcome have not been independently validated. The aim of this study was to validate these markers using data from the CORAL trial. METHODS All patients randomized in the CORAL trial to RAS were included. American Heart Association guidelines were used to categorize patients as BP responders or nonresponders to RAS. BP responders were defined by a postoperative BP <160/90 mm Hg with a reduced number of antihypertensive medications or a reduction in diastolic BP to <90 mm Hg with the same medications after RAS. Patients with stable or worsened BP were labeled nonresponders. Variables associated with a favorable BP response were identified by multivariable logistic regression analysis. RESULTS There were 436 patients who underwent RAS with a median age of 70 years (interquartile range [IQR], 63-76 years). The median systolic and diastolic BPs of the stented cohort at baseline were 149 mm Hg (IQR, 132-164 mm Hg) and 78 mm Hg (IQR, 70-87 mm Hg), respectively. A positive BP response occurred in 284 of 436 (65.1%) stented patients. Multivariable logistic regression analysis identified three independent markers of a positive BP response: requirement for four or more medications (odds ratio, 5.9; P < .001), preoperative diastolic BP >90 mm Hg (odds ratio 13.9; P < .001), and preoperative clonidine use (odds ratio, 4.52; P = .008). The percentage of patients with a positive BP response increased incrementally as the number of markers per patient increased, based on the Cochran-Armitage test for trend (P < .0001). CONCLUSIONS In patients from the CORAL trial who underwent RAS, the previously reported clinical markers of BP response were validated. A prospective trial to validate their utility as predictors of BP response to RAS is warranted.
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Affiliation(s)
- J Gregory Modrall
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Tex; Surgical Service, Dallas Veterans Affairs Medical Center, Dallas, Tex.
| | - Hong Zhu
- Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, Tex
| | - Fred A Weaver
- Division of Vascular and Endovascular Surgery, Department of Surgery, Keck School of Medicine at the University of Southern California, Los Angeles, Calif
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de Souza Alves Ferreira R, Attab Dos Santos JL, Greguolo C, Fabris JF, D'anzicourt Pinto M, Nascimento Paiva A, Resende VP, de Souza CF, Mandaloufas LC, Alves de Urzêda M, Sanchez Antonio R. Acute Renal Infarction Treated With Local Intra-arterial Thrombolysis. J Invasive Cardiol 2020; 32:E15-E16. [PMID: 31893508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
A 53-year-old man with stable coronary disease and dyslipidemia was admitted with sudden pain of severe intensity in the left flank. Selective catheterization of the left renal artery, followed by alteplase infusion for 6 hours, resolved the patient's symptoms.
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Vijayvergiya R, Budhakoty S, Kumar B, Kasinadhuni G, Kanabar K. Percutaneous Renal Artery Stenting With Optical Coherence Tomography Imaging in a Young Boy With Recanalized-Thrombus Associated Renal Artery Stenosis. J Invasive Cardiol 2020; 32:E9-E10. [PMID: 31893504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The common cause of renal artery stenosis in young is fibromuscular dysplasia or Takayasu arteritis. Recanalized thrombus, on the other hand, is a rare cause for renal artery stenosis in young patients. OCT imaging confirmed the diagnosis and optimized the renal stenting results.
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Affiliation(s)
- Rajesh Vijayvergiya
- Department of Cardiology, Advanced Cardiac Centre, Post Graduate Institute of Medical Education & Research, Sector 12, Chandigarh - 160 012, India.
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Abstract
Discovered in 1987 as a potent endothelial cell-derived vasoconstrictor peptide, endothelin-1 (ET-1), the predominant member of the endothelin peptide family, is now recognized as a multifunctional peptide with cytokine-like activity contributing to almost all aspects of physiology and cell function. More than 30 000 scientific articles on endothelin were published over the past 3 decades, leading to the development and subsequent regulatory approval of a new class of therapeutics-the endothelin receptor antagonists (ERAs). This article reviews the history of the discovery of endothelin and its role in genetics, physiology, and disease. Here, we summarize the main clinical trials using ERAs and discuss the role of endothelin in cardiovascular diseases such as arterial hypertension, preecclampsia, coronary atherosclerosis, myocardial infarction in the absence of obstructive coronary artery disease (MINOCA) caused by spontaneous coronary artery dissection (SCAD), Takotsubo syndrome, and heart failure. We also discuss how endothelins contributes to diabetic kidney disease and focal segmental glomerulosclerosis, pulmonary arterial hypertension, as well as cancer, immune disorders, and allograft rejection (which all involve ETA autoantibodies), and neurological diseases. The application of ERAs, dual endothelin receptor/angiotensin receptor antagonists (DARAs), selective ETB agonists, novel biologics such as receptor-targeting antibodies, or immunization against ETA receptors holds the potential to slow the progression or even reverse chronic noncommunicable diseases. Future clinical studies will show whether targeting endothelin receptors can prevent or reduce disability from disease and improve clinical outcome, quality of life, and survival in patients.
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Affiliation(s)
- Matthias Barton
- From Molecular Internal Medicine, University of Zürich, Switzerland (M.B.)
- Andreas Grüntzig Foundation, Zürich, Switzerland (M.B.)
| | - Masashi Yanagisawa
- International Institute for Integrative Sleep Medicine (WPI-IIIS) and Life Science Center, Tsukuba Advanced Research Alliance, University of Tsukuba, Japan (M.Y.)
- Department of Molecular Genetics, University of Texas Southwestern Medical Center, Dallas, TX (M.Y.)
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Mehta OH, Cameron JD, Mirzaee S. Familial Hypercholesterolemia With Coexisting Renovascular Stenosis and Premature Coronary Artery Disease. Am J Hypertens 2019; 32:730-733. [PMID: 30868157 DOI: 10.1093/ajh/hpz037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 02/17/2019] [Accepted: 03/06/2019] [Indexed: 11/12/2022] Open
Abstract
Familial hypercholesterolemia (FH) is a common hereditary lipid disorder associated with substantial risk of premature atherosclerotic cardiovascular disease. We report an interesting newly diagnosed index case of FH in a 31-year-old man who presented to the hospital with an ST-elevated myocardial infarction. He had a background of inadequately treated hypertension and hypercholesterolemia. Further investigations raised the possibility of secondary hypertension after the identification of renal artery stenosis, in addition to other areas of mesenteric arterial stenoses. Our patient's case highlights that early-onset hypertension and hypercholesterolemia in a young individual may be an early manifestation of FH requiring high clinical vigilance and awareness.
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Affiliation(s)
- Ojas H Mehta
- Monash Cardiovascular Research Centre, MonashHEART, Monash Health, Monash University, Melbourne, Australia
| | - James D Cameron
- Monash Cardiovascular Research Centre, MonashHEART, Monash Health, Monash University, Melbourne, Australia
| | - Sam Mirzaee
- Monash Cardiovascular Research Centre, MonashHEART, Monash Health, Monash University, Melbourne, Australia
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13
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Jiang K, Ferguson CM, Abumoawad A, Saad A, Textor SC, Lerman LO. A modified two-compartment model for measurement of renal function using dynamic contrast-enhanced computed tomography. PLoS One 2019; 14:e0219605. [PMID: 31291361 PMCID: PMC6619810 DOI: 10.1371/journal.pone.0219605] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 06/27/2019] [Indexed: 12/14/2022] Open
Abstract
Objectives To validate and adapt a modified two-compartment model, originally developed for magnetic resonance imaging, for measuring human single-kidney glomerular filtration rate (GFR) and perfusion using dynamic contrast-enhanced computed tomography (DCE-CT). Methods This prospective study was approved by the institutional review board, and written informed consent was obtained from all patients. Thirty-eight patients with essential hypertension (EH, n = 13) or atherosclerotic renal artery stenosis (ARAS, n = 25) underwent renal DCE-CT for GFR and perfusion measurement using a modified two-compartment model. Iothalamate clearance was used to measure reference total GFR, which was apportioned into single-kidney GFR by renal blood flow. Renal perfusion was also calculated using a conventional deconvolution algorithm. Validation of GFR and perfusion and inter-observer reproducibility, were conducted by using the Pearson correlation and Bland-Altman analysis. Results Both the two-compartment model and iothalamate clearance detected in ARAS patients lower GFR in the stenotic compared to the contralateral and EH kidneys. GFRs measured by DCE-CT and iothalamate clearance showed a close match (r = 0.94, P<0.001, and mean difference 2.5±12.2mL/min). Inter-observer bias and variation in model-derived GFR (r = 0.97, P<0.001; mean difference, 0.3±7.7mL/min) were minimal. Renal perfusion by deconvolution agreed well with that by the compartment model when the blood transit delay from abdominal aorta to kidney was negligible. Conclusion The proposed two-compartment model faithfully depicts contrast dynamics using DCE-CT and may provide a reliable tool for measuring human single-kidney GFR and perfusion.
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Affiliation(s)
- Kai Jiang
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Christopher M. Ferguson
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Abdelrhman Abumoawad
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Ahmed Saad
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Stephen C. Textor
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Lilach O. Lerman
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, United States of America
- * E-mail:
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14
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Sens F, Normand G, Fournier T, Della-Schiava N, Luong S, Pelletier C, Robinson P, Lemoine S, Rouvière O, Juillard L. Blood pressure decreases after revascularization in atherosclerotic renal artery disease: A cohort study based on a multidisciplinary meeting. PLoS One 2019; 14:e0218788. [PMID: 31233539 PMCID: PMC6590822 DOI: 10.1371/journal.pone.0218788] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 06/10/2019] [Indexed: 01/22/2023] Open
Abstract
Background In atherosclerotic renal artery disease, the benefit of revascularization is controversial. A clinical decision-making process based on a multidisciplinary meeting was formalized in the Lyon university hospital. Objectives To investigate whether this decisional process ensured a clinical benefit to patients assigned to renal revascularization. Methods Single-centre retrospective cohort study, including patients diagnosed from April 2013 to February 2015 with an atherosclerotic renal artery disease with a peak systolic velocity >180cm/s. For each patient, the decision taken in multidisciplinary meeting (medical treatment or revacularization) was compared to the one guided by international guidelines. Blood pressure values, number of antihypertensive medications, presence of an uncontrolled or resistant hypertension, and glomerular filtration rate at one-year follow-up were compared to baseline values. Safety data were collected. Results Forty-nine patients were included: 26 (53%) were assigned to a medical treatment and 23 (47%) to a renal revascularization. Therapeutic decision was in accordance with the 2013 American Health Association guidelines and with the 2017 European Society of Cardiology guidelines for 78% and 22% of patients who underwent revascularization, respectively. Patients assigned to revascularization presented a significant decrease in systolic blood pressure (-23±34mmHg, p = 0.007), diastolic blood pressure (-12±18mmHg, p = 0.007), number of antihypertensive medications (-1.00±1.03, p = 0.001), and number of uncontrolled or resistant hypertension (p = 0.022 and 0.031) at one-year follow-up. Those parameters were not modified among patients assigned to medical treatment alone. There was no grade 3 adverse event. Conclusion Based on a multidisciplinary selection of revascularization indications, patients on whom a renal revascularization was performed exhibited a significant improvement of blood pressure control parameters with no severe adverse events.
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Affiliation(s)
- Florence Sens
- Department of Nephrology, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
- Lyon 1 Claude Bernard University, Villeurbanne, France
- FCRIN INI-CRCT, Nancy, France
- * E-mail:
| | - Gabrielle Normand
- Department of Nephrology, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
- Lyon 1 Claude Bernard University, Villeurbanne, France
| | - Thomas Fournier
- Department of Nephrology, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | - Nellie Della-Schiava
- Department of Vascular Surgery, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | - Stéphane Luong
- Department of Urinary and Vascular Imaging, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | - Caroline Pelletier
- Department of Nephrology, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
- Lyon 1 Claude Bernard University, Villeurbanne, France
| | - Philip Robinson
- Direction de la Recherche Clinique et de l’Innovation, Hospices Civils de Lyon, Lyon, France
| | - Sandrine Lemoine
- Department of Nephrology, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
- Lyon 1 Claude Bernard University, Villeurbanne, France
- FCRIN INI-CRCT, Nancy, France
| | - Olivier Rouvière
- Lyon 1 Claude Bernard University, Villeurbanne, France
- Department of Urinary and Vascular Imaging, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | - Laurent Juillard
- Department of Nephrology, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
- Lyon 1 Claude Bernard University, Villeurbanne, France
- FCRIN INI-CRCT, Nancy, France
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15
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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16
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Duan Y, Xiang F, Li Q, Li K, Grajo JR, Samir AE. Predictive Value of Duplex Ultrasound for Significant In-Stent Restenosis after Percutaneous Transluminal Renal Artery Stent Placement: A Propensity Score Matching Analysis. Ultrasound Med Biol 2019; 45:913-920. [PMID: 30655110 PMCID: PMC7580866 DOI: 10.1016/j.ultrasmedbio.2018.11.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 10/03/2018] [Accepted: 11/19/2018] [Indexed: 06/09/2023]
Abstract
To evaluate the value of pre-stenting and early post-stenting (<1 mo) duplex ultrasound parameters in predicting significant in-stent restenosis (ISR), we matched significant ISR patients 1:1 with controls without ISR in pre-stenting and early post-stenting (<1 mo) periods, respectively, using propensity score matching. Duplex ultrasound parameters, such as renal length difference between non-lesion side and lesion side within patient, trans-lesion peak systolic velocity and renal aortic ratio, were compared between cases and controls, and the area under the receiver operating characteristic curve (AUROC) was charted to predict ISR. After propensity score matching, 28 cases were matched in the pre-stenting period and 16 cases in the early post-stenting time period. Pre-stenting renal length difference, early post-stenting peak systolic velocity and renal aortic ratio showed significant differences in case-control comparisons. Early post-stenting peak systolic velocity (AUROC: 0.826, cutoff: 141 cm/s) and renal aortic ratio (AUROC: 0.770, cutoff: 1.75) performed well in predicting significant ISR and may serve as non-invasive markers in ISR surveillance.
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Affiliation(s)
- Yu Duan
- Department of Medical Ultrasonics, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China; Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Feixiang Xiang
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Qian Li
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Kaiwen Li
- Department of Urology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Joseph R Grajo
- Division of Abdominal Imaging, Department of Radiology, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Anthony E Samir
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.
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17
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Abumoawad A, Saad A, Ferguson CM, Eirin A, Woollard JR, Herrmann SM, Hickson LJ, Bendel EC, Misra S, Glockner J, Lerman LO, Textor SC. Tissue hypoxia, inflammation, and loss of glomerular filtration rate in human atherosclerotic renovascular disease. Kidney Int 2019; 95:948-957. [PMID: 30904069 PMCID: PMC6738340 DOI: 10.1016/j.kint.2018.11.039] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 11/15/2018] [Accepted: 11/29/2018] [Indexed: 12/18/2022]
Abstract
The relationships between renal blood flow (RBF), tissue oxygenation, and inflammatory injury in atherosclerotic renovascular disease (ARVD) are poorly understood. We sought to correlate RBF and tissue hypoxia with glomerular filtration rate (GFR) in 48 kidneys from patients with ARVD stratified by single kidney iothalamate GFR (sGFR). Oxygenation was assessed by blood oxygenation level dependent magnetic resonance imaging (BOLD MRI), which provides an index for the levels of deoxyhemoglobin within a defined volume of tissue (R2*). sGFR correlated with RBF and with the severity of vascular stenosis as estimated by duplex velocities. Higher cortical R2* and fractional hypoxia and higher levels of renal vein neutrophil-gelatinase-associated-lipocalin (NGAL) and monocyte-chemoattractant protein-1 (MCP-1) were observed at lower GFR, with an abrupt inflection below 20 ml/min. Renal vein MCP-1 levels correlated with cortical R2* and with fractional hypoxia. Correlations between cortical R2* and RBF in the highest sGFR stratum (mean sGFR 51 ± 12 ml/min; R = -0.8) were degraded in the lowest sGFR stratum (mean sGFR 8 ± 3 ml/min; R = -0.1). Changes in fractional hypoxia after furosemide were also absent in the lowest sGFR stratum. These data demonstrate relative stability of renal oxygenation with moderate reductions in RBF and GFR but identify a transition to overt hypoxia and inflammatory cytokine release with severely reduced GFR. Tissue oxygenation and RBF were less correlated in the setting of reduced sGFR, consistent with variable oxygen consumption or a shift to alternative mechanisms of tissue injury. Identifying transitions in tissue oxygenation may facilitate targeted therapy in ARVD.
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Affiliation(s)
| | - Ahmed Saad
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, USA; Department of Family Medicine, Creighton University, Omaha, Nebraska, USA
| | | | - Alfonso Eirin
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, USA
| | - John R Woollard
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, USA
| | - Sandra M Herrmann
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, USA
| | - LaTonya J Hickson
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, USA
| | - Emily C Bendel
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Sanjay Misra
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - James Glockner
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Lilach O Lerman
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, USA
| | - Stephen C Textor
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, USA.
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18
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Dong H, Ou Y, Nie Z, Huang W, Liu Y, Zhou Y, Luo J, Li G. Association of renal artery stenosis with left ventricular remodeling in patients coexisting with renovascular and coronary artery disease. Vascular 2018; 27:190-198. [PMID: 30547720 DOI: 10.1177/1708538118819676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Data about renal artery stenosis association with left ventricular remodeling in patients coexisting with coronary artery disease are scanty. METHODS Patients with suspected both coronary artery disease and renal artery stenosis undergoing coronary and renal arteriography between October 2013 and December 2015 were prospectively enrolled. Left ventricular remodeling patterns were compared among different severity of renal artery stenosis group. Logistic regression was done to investigate the determinants of the left ventricular morphology. RESULTS The overall prevalence of left ventricular hypertrophy was 40.5%, the highest in bilateral renal artery stenosis group compared to unilateral or normal ones (65.4% versus 41.8% versus 34.8%, p = 0.012). Significantly lower estimated glomerular filtration rate and higher cystatin C level were found in bilateral renal artery stenosis group than that in other two groups. Multivariate regression analysis showed that bilateral renal artery stenosis was associated with increased left ventricular hypertrophy and concentric hypertrophy with statistical significance (adjusted odds ratio = 2.909 (95%CI: 1.063-7.961), and 3.021 (95%CI: 1.136-8.033)). In addition, estimated glomerular filtration rate level was also related to left ventricular hypertrophy, while there was no significant interaction between renal artery stenosis and coronary artery disease on left ventricular hypertrophy/concentric hypertrophy occurrence. CONCLUSIONS Bilateral renal artery stenosis is significantly associated with increased left ventricular hypertrophy/concentric hypertrophy in patients with suspected concomitant coronary and renal artery disease, while no synergic effect could be found in coronary artery disease.
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Affiliation(s)
- Haojian Dong
- 1 Department of Cardiology, Vascular Center, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangdong, People's Republic of China
| | - Yanqiu Ou
- 2 Department of Epidemiology, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangdong, People's Republic of China
| | - Zhiqiang Nie
- 2 Department of Epidemiology, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangdong, People's Republic of China
| | - Wenhui Huang
- 1 Department of Cardiology, Vascular Center, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangdong, People's Republic of China
| | - Yuan Liu
- 1 Department of Cardiology, Vascular Center, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangdong, People's Republic of China
| | - Yingling Zhou
- 1 Department of Cardiology, Vascular Center, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangdong, People's Republic of China
| | - Jianfang Luo
- 1 Department of Cardiology, Vascular Center, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangdong, People's Republic of China
| | - Guang Li
- 1 Department of Cardiology, Vascular Center, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangdong, People's Republic of China
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19
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Zhu R, Xu Z, Qi Z, Ye W, Wang J, Kong J, Jin J, Li J. How to diagnose renal artery stenosis correctly using ultrasound? Evaluation of results of renal arteries duplex ultrasonography examinations. Med Ultrason 2018; 20:298-305. [PMID: 30167582 DOI: 10.11152/mu-1341] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
AIM Renal artery duplex ultrasonography (RDU) is an effective and non-invasive screening test in diagnosing renal artery stenosis. The discordance of results in multiple RDU is common. We aim to evaluate the discordance and the reasons for discordance between diagnoses and measurements from multiple RDU examinations. MATERIAL AND METHOD A retrospective study was performed in 64 examinations of renal arteries from 32 patients that were referred for two or more RDU examinations and renal artery digital subtraction angiography (DSA) within six months, between August 2013 and January 2016. Using DSA as gold standard, we divided the renal arteries into three groups: discordant (one diagnosis of RDU was correct and one was wrong), misdiagnosed (neither RDU diagnosis was correct) and correct (both RDU diagnoses were correct) groups.We evaluated the discordance and reasons for discordance of diagnoses and measurements from multiple RDU examinations. Results: Among 64 renal arteries included in this study, 37 renal arteries had two correct diagnoses, 19 renal arteries had two discordant diagnoses, and eight renal arteries were misdiagnosed twice by RDU. The discordance of peak systolic velocity (PSV), the ratio between PSV in the renal artery with stenosis and PSV in the aorta (RAR), and tardus-parvus waveform measurements were clearly higher in the discordant diagnoses group than in the correctly diagnosed group. The most common reason for a discordant diagnosis was failure in obtaining correct tardus-parvus waveforms of the interlobar artery (26.31%). Themost common reason for misdiagnosis was the presence of an extremely severe stenosis with an atrophic kidney (31.25%). Overall, 87.50% of patients underwent RDU examinations had correct diagnoses of stenosis or occlusion at least once (including location and degree), as confirmed by DSA. CONCLUSIONS Our study indicates that standard operating procedures and improvements in examination technique by ultrasound doctors could reduce the discordance between multiple tests.
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Affiliation(s)
- Rong Zhu
- Department of Ultrasound, Peking Union Medical College Hospital (PUMCH), Chinese Academe of Medical Sciences & Peking Union Medical College (CAMS & PUMC), Beijing, 100730, China.
| | - Zhonghui Xu
- Department of Ultrasound, Peking Union Medical College Hospital (PUMCH), Chinese Academe of Medical Sciences & Peking Union Medical College (CAMS & PUMC), Beijing, 100730, China.
| | - Zhenhong Qi
- Department of Ultrasound, Peking Union Medical College Hospital (PUMCH), Chinese Academe of Medical Sciences & Peking Union Medical College (CAMS & PUMC), Beijing, 100730, China.
| | - We Ye
- Department of Vascular Surgery, Peking Union Medical College Hospital (PUMCH), Chinese Academe of Medical Sciences & Peking Union Medical College (CAMS & PUMC), Beijing, 100730, China.
| | - Jian Wang
- Department of Ultrasound, First Affiliated Hospital of Shanxi Medical University, Taiyuan, Shanxi Province, 030001, China.
| | - Jing Kong
- Department of Ultrasound, Peking Union Medical College Hospital (PUMCH), Chinese Academe of Medical Sciences & Peking Union Medical College (CAMS & PUMC), Beijing, 100730, China.
| | - Jin Jin
- Department of Ultrasound, Peking Union Medical College Hospital (PUMCH), Chinese Academe of Medical Sciences & Peking Union Medical College (CAMS & PUMC), Beijing, 100730, China.
| | - Jianchu Li
- Department of Ultrasound, Peking Union Medical College Hospital (PUMCH), Chinese Academe of Medical Sciences & Peking Union Medical College (CAMS & PUMC), Beijing, 100730, China.
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20
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Gigante A, Zingaretti V, Proietti M, Rosato E, Cianci R. Autonomic dysfunction and cardiovascular risk in patients with atherosclerotic renal artery stenosis: A pilot study. Eur J Intern Med 2018. [PMID: 29525508 DOI: 10.1016/j.ejim.2018.03.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Antonietta Gigante
- Department of Clinical Medicine, Sapienza-University of Rome, Rome, Italy.
| | - Viviana Zingaretti
- Department of Clinical Medicine, Sapienza-University of Rome, Rome, Italy
| | - Marco Proietti
- IRCCS - Istituto di Ricerche Farmacologiche Mario Negri, Milano, Italy; Department of Internal Medicine and Medical Specialties, Sapienza-University of Rome, Rome, Italy
| | - Edoardo Rosato
- Department of Clinical Medicine, Sapienza-University of Rome, Rome, Italy
| | - Rosario Cianci
- Department of Clinical Medicine, Sapienza-University of Rome, Rome, Italy
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21
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Zhang X, Zhu X, Ferguson CM, Jiang K, Burningham T, Lerman A, Lerman LO. Magnetic resonance elastography can monitor changes in medullary stiffness in response to treatment in the swine ischemic kidney. MAGMA 2018; 31:375-382. [PMID: 29289980 PMCID: PMC5976551 DOI: 10.1007/s10334-017-0671-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Revised: 12/14/2017] [Accepted: 12/20/2017] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Low-energy shockwave (SW) therapy attenuates damage in the stenotic kidney (STK) caused by atherosclerotic renal artery stenosis (ARAS). We hypothesized that magnetic resonance elastography (MRE) would detect attenuation of fibrosis following SW in unilateral ARAS kidneys. MATERIALS AND METHODS Domestic pigs were randomized to control, unilateral ARAS, and ARAS treated with 6 sessions of SW over 3 consecutive weeks (n = 7 each) starting after 3 weeks of ARAS or sham. Four weeks after SW treatment, renal fibrosis was evaluated with MRE in vivo or trichrome staining ex vivo. Blood pressure, single-kidney renal-blood-flow (RBF) and glomerular-filtration-rate (GFR) were assessed. RESULTS MRE detected increased stiffness in the STK medulla (15.3 ± 2.1 vs. 10.1 ± 0.8 kPa, p < 0.05) that moderately correlated with severity of fibrosis (R2 = 0.501, p < 0.01), but did not identify mild STK cortical or contralateral kidney fibrosis. Trichrome staining showed that medullary fibrosis was increased in ARAS and alleviated by SW (10.4 ± 1.8% vs. 2.9 ± 0.2%, p < 0.01). SW slightly decreased blood pressure and normalized STK RBF and GFR in ARAS. In the contralateral kidney, SW reversed the increase in RBF and GFR. CONCLUSION MRE might be a tool for noninvasive monitoring of medullary fibrosis in response to treatment in kidney disease.
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Affiliation(s)
- Xin Zhang
- Division of Nephrology and Hypertension, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Xiangyang Zhu
- Division of Nephrology and Hypertension, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | | | - Kai Jiang
- Division of Nephrology and Hypertension, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Tyson Burningham
- Division of Nephrology and Hypertension, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Amir Lerman
- Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Lilach Orly Lerman
- Division of Nephrology and Hypertension, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
- Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
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22
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Vitadello T, Renders L, Münzel D, Huber A, Ibrahim T. Late renal revascularization and salvage due to unexpected collaterals. Kidney Int 2018; 93:1491. [PMID: 29792276 DOI: 10.1016/j.kint.2017.11.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 10/06/2017] [Accepted: 11/06/2017] [Indexed: 11/19/2022]
Affiliation(s)
- Teresa Vitadello
- Klinik und Poliklinik für Innere Medizin 1, Klinikum Rechts der Isar, Technische Universität München, Munich, Germany.
| | - Lutz Renders
- Abteilung für Nephrologie, Klinikum Rechts der Isar, Technische Universität München, Munich, Germany
| | - Daniela Münzel
- Institut für diagnostische und interventionelle Radiologie, Klinikum Rechts der Isar, Technische Universität München, Munich, Germany
| | - Armin Huber
- Institut für diagnostische und interventionelle Radiologie, Klinikum Rechts der Isar, Technische Universität München, Munich, Germany
| | - Tareq Ibrahim
- Klinik und Poliklinik für Innere Medizin 1, Klinikum Rechts der Isar, Technische Universität München, Munich, Germany
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23
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刘 燕, 于 立, 邓 文, 李 凯, 刘 如, 叶 桂, 符 芳, 李 江, 苗 芸. [A high level of high-density lipoprotein cholesterol is a protective factor against transplant renal artery stenosis]. Nan Fang Yi Ke Da Xue Xue Bao 2018; 38:155-161. [PMID: 29502053 PMCID: PMC6743882 DOI: 10.3969/j.issn.1673-4254.2018.02.06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To investigate the factors associated with the occurrence of transplant renal artery stenosis (TRAS). METHODS A retrospective analysis was conducted in 26 recipients who developed TRAS and 40 concurrent renal recipients without TRAS. We also conducted a nested case-control study in 14 patients with TRAS (TRAS-SD group) and another 14 non-TRAS recipients who received the allograft from the same donor (non-TRAS-SD group). RESULTS Compared with those in the concurrent recipients without TRAS, acute rejection (AR) occurred at a significantly higher incidence (P=0.004) and the warm ischemia time (WIT) was significantly longer (P=0.015) and the level of high?density lipoprotein cholesterol (HDL--C) significantly lower (P=0.009) in the recipients with TRAS. Logistic regression analysis suggested that AR (P=0.007) and prolonged WIT (P=0.046) were risk factors of TRAS while HDL-C (P=0.022) was the protective factor against TRAS. In recent years early diagnosis of TRAS had been made in increasing cases, the interval from transplantation to TRAS diagnosis became shortened steadily, and the recipients tended to have higher estimated glomerular filtration rate at the time of TRAS diagnosis. CONCLUSION Apart from the surgical technique, AR and prolonged WIT are also risk factors of TRAS while a high HDL-C level is the protective factor against TRAS. The improvement of the diagnostic accuracy by ultrasound is the primary factor contributing to the increased rate of early TRAS diagnosis in recent years.
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Affiliation(s)
- 燕娜 刘
- />南方医科大学南方医院器官移植科,广州 广东 510515Department of Organ Transplantation, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - 立新 于
- />南方医科大学南方医院器官移植科,广州 广东 510515Department of Organ Transplantation, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - 文锋 邓
- />南方医科大学南方医院器官移植科,广州 广东 510515Department of Organ Transplantation, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - 凯群 李
- />南方医科大学南方医院器官移植科,广州 广东 510515Department of Organ Transplantation, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - 如敏 刘
- />南方医科大学南方医院器官移植科,广州 广东 510515Department of Organ Transplantation, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - 桂荣 叶
- />南方医科大学南方医院器官移植科,广州 广东 510515Department of Organ Transplantation, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - 芳翔 符
- />南方医科大学南方医院器官移植科,广州 广东 510515Department of Organ Transplantation, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - 江涛 李
- />南方医科大学南方医院器官移植科,广州 广东 510515Department of Organ Transplantation, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - 芸 苗
- />南方医科大学南方医院器官移植科,广州 广东 510515Department of Organ Transplantation, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
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Qiu C, Shao J, Liu X, Liu B. Utilizing flat-panel detector parenchymal blood volume imaging (FD-PBV) for quantitative kidney perfusion analysis during the process of percutaneous transluminal renal angioplasty (PTRA): A case report. Medicine (Baltimore) 2017; 96:e8654. [PMID: 29381939 PMCID: PMC5708938 DOI: 10.1097/md.0000000000008654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Traditional digital subtraction angiography (DSA) provides lumen morphology of renal artery as indicators for vascular patency in patients with renal artery stenosis (RAS). It, however, lacks hemodynamic information toward target kidney. To solve this shortcoming, a novel technique, flat-panel detector parenchymal blood volume imaging (FD-PBV), is introduced, which is able to evaluate hemodynamic changes of target kidney intraoperatively. PATIENTS CONCERNS A 77-year-old female presented with hypertension, intermittent dizziness, nausea, and fatigue. DIAGNOSES Ninety-nine percent stenosis of left RAS was found. INTERVENTIONS Percutaneous transluminal renal angioplasty was performed, along with FD-PBV acquisition protocol. OUTCOMES Her symptoms relieved gradually after procedure. Intuitive FD-PBV maps showed her renal perfusion improved remarkably. Quantitative analysis of FD-PBV showed her kidney volume was 47.02 and 75.61 cm with average density of contrast medium (CM) 58.1 HU and 311.5 HU before and after stenting. Follow-up at 6 months showed patency of the stent and stable kidney blood perfusion. LESSONS FD-PBV technique possesses a remarkable value in quantitatively assessing the changes of kidney blood perfusion and can be a useful auxiliary technique for DSA.
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Chrysochou C, Green D, Ritchie J, Buckley DL, Kalra PA. Kidney volume to GFR ratio predicts functional improvement after revascularization in atheromatous renal artery stenosis. PLoS One 2017; 12:e0177178. [PMID: 28594847 PMCID: PMC5464522 DOI: 10.1371/journal.pone.0177178] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Accepted: 04/22/2017] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Randomized controlled trials (RCT) have shown no overall benefit of renal revascularization in atherosclerotic renovascular disease (ARVD). However, 25% of patients demonstrate improvement in renal function. We used the ratio of magnetic resonance parenchymal volume (PV) to isotopic single kidney glomerular filtration rate (isoSKGFR) ratio as our method to prospectively identify "improvers" before revascularization. METHODS Patients with renal artery stenosis who were due revascularization were recruited alongside non-ARVD hypertensive CKD controls. Using the controls, 95% CI were calculated for expected PV:isoSK-GFR at given renal volumes. For ARVD patients, "improvers" were defined as having both >15% and >1ml/min increase in isoSK-GFR at 4 months after revascularization. Sensitivity and specificity of PV:isoSK-GFR for predicting improvers was calculated. RESULTS 30 patients (mean age 68 ±8 years), underwent revascularization, of whom 10 patients had intervention for bilateral RAS. Stented kidneys which manifested >15% improvement in function had larger PV:isoSK-GFR compared to controls (19±16 vs. 6±4ml/ml/min, p = 0.002). The sensitivity and specificity of this equation in predicting a positive renal functional outcome were 64% and 88% respectively. Use of PV:isoSK-GFR increased prediction of functional improvement (area under curve 0.93). Of note, non-RAS contralateral kidneys which improved (n = 5) also demonstrated larger PV:isoSK-GFR (15.2±16.2 ml/ml/min, p = 0.006). CONCLUSION This study offers early indicators that the ratio of PV:isoSK-GFR may help identify patients with kidneys suitable for renal revascularization which could improve patient selection for a procedure associated with risks. Calculation of the PV:isoSK-GFR ratio is easy, does not require MRI contrast agent.
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Affiliation(s)
- Constantina Chrysochou
- The University of Manchester, Manchester Academic Health Science Centre, Salford Royal NHS Foundation Trust, Stott Lane, Salford, United Kingdom
| | - Darren Green
- The University of Manchester, Manchester Academic Health Science Centre, Salford Royal NHS Foundation Trust, Stott Lane, Salford, United Kingdom
| | - James Ritchie
- The University of Manchester, Manchester Academic Health Science Centre, Salford Royal NHS Foundation Trust, Stott Lane, Salford, United Kingdom
| | - David L. Buckley
- Division of Biomedical Imaging, University of Leeds, LIGHT Laboratories, Leeds, United Kingdom
| | - Philip A. Kalra
- The University of Manchester, Manchester Academic Health Science Centre, Salford Royal NHS Foundation Trust, Stott Lane, Salford, United Kingdom
- * E-mail:
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van Brussel PM, van de Hoef TP, de Winter RJ, Vogt L, van den Born BJ. Hemodynamic Measurements for the Selection of Patients With Renal Artery Stenosis: A Systematic Review. JACC Cardiovasc Interv 2017; 10:973-985. [PMID: 28521931 DOI: 10.1016/j.jcin.2017.02.046] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Revised: 01/27/2017] [Accepted: 02/12/2017] [Indexed: 11/25/2022]
Abstract
Interventions targeting renal artery stenoses have been shown to lower blood pressure and preserve renal function. In recent studies, the efficacy of catheter-based percutaneous transluminal renal angioplasty with stent placement has been called into question. In the identification of functional coronary lesions, hyperemic measurements have earned a place in daily practice for clinical decision making, allowing discrimination between solitary coronary lesions and diffuse microvascular disease. Next to differences in clinical characteristics, the selection of renal arteries suitable for intervention is currently on the basis of anatomic grading of the stenosis by angiography rather than functional assessment under hyperemia. It is conceivable that, like the coronary circulation, functional measurements may better predict therapeutic efficacy of percutaneous transluminal renal angioplasty with stent placement. In this systematic review, the authors evaluate the available clinical evidence on the optimal hyperemic agents to induce intrarenal hyperemia, their association with anatomic grading, and their predictive value for treatment effects. In addition, the potential value of combined pressure and flow measurements to discriminate macrovascular from microvascular disease is discussed.
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Affiliation(s)
- Peter M van Brussel
- Heart Center, Department of Interventional Cardiology, Academic Medical Center, Amsterdam, the Netherlands
| | - Tim P van de Hoef
- Heart Center, Department of Interventional Cardiology, Academic Medical Center, Amsterdam, the Netherlands
| | - Robbert J de Winter
- Heart Center, Department of Interventional Cardiology, Academic Medical Center, Amsterdam, the Netherlands
| | - Liffert Vogt
- Department of Nephrology, Academic Medical Center, Amsterdam, the Netherlands
| | - Bert-Jan van den Born
- Department of Vascular Medicine, Academic Medical Center, Amsterdam, the Netherlands.
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Drummond CA, Brewster PS, He W, Ren K, Xie Y, Tuttle KR, Haller ST, Jamerson K, Dworkin LD, Cutlip DE, Murphy TP, D’Agostino RB, Henrich WL, Tian J, Shapiro JI, Cooper CJ. Cigarette smoking and cardio-renal events in patients with atherosclerotic renal artery stenosis. PLoS One 2017; 12:e0173562. [PMID: 28306749 PMCID: PMC5357000 DOI: 10.1371/journal.pone.0173562] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Accepted: 02/22/2017] [Indexed: 11/22/2022] Open
Abstract
Cigarette smoking causes cardiovascular disease and is associated with poor kidney function in individuals with diabetes mellitus and primary kidney diseases. However, the association of smoking on patients with atherosclerotic renal artery stenosis has not been studied. The current study utilized data from the Cardiovascular Outcomes in Renal Atherosclerotic Lesions (CORAL, NCT00081731) clinical trial to evaluate the effects of smoking on the risk of cardio-renal events and kidney function in this population. Baseline data showed that smokers (n = 277 out of 931) were significantly younger at enrollment than non-smokers (63.3±9.1 years vs 72.4±7.8 years; p<0.001). In addition, patients who smoke were also more likely to have bilateral renal artery stenoses and peripheral vascular disease (PVD). Longitudinal analysis showed that smokers experienced composite endpoint events (defined as first occurrence of: stroke; cardiovascular or renal death; myocardial infarction; hospitalization for congestive heart failure; permanent renal replacement; and progressive renal insufficiency defined as 30% reduction of GFR from baseline sustained for ≥ 60 days) at a substantially younger age compared to non-smokers (67.1±9.0 versus 76.1±7.9, p<0.001). Using linear regression and generalized linear modeling analysis controlled by age, sex, and ethnicity, smokers had significantly higher cystatin C levels (1.3±0.7 vs 1.2±0.9, p<0.01) whereas creatinine and estimated glomerular filtration rate (eGFR) were not different from non-smokers. From these data we conclude that smoking has a significant association with deleterious cardio-renal outcomes in patients with renovascular hypertension.
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Affiliation(s)
- Christopher A. Drummond
- Department of Medicine, University of Toledo College of Medicine and Life Sciences, Toledo, OH, United States of America
| | - Pamela S. Brewster
- Department of Medicine, University of Toledo College of Medicine and Life Sciences, Toledo, OH, United States of America
| | - Wencan He
- Department of Mathematics, University of Toledo, Toledo, OH, United States of America
| | - Kaili Ren
- Department of Mathematics, University of Toledo, Toledo, OH, United States of America
| | - Yanmei Xie
- Department of Mathematics, University of Toledo, Toledo, OH, United States of America
| | - Katherine R. Tuttle
- Division of Nephrology, University of Washington School of Medicine, Providence Health Care, Spokane, WA, United States of America
| | - Steven T. Haller
- Department of Medicine, University of Toledo College of Medicine and Life Sciences, Toledo, OH, United States of America
| | - Kenneth Jamerson
- Department of Medicine, University of Michigan, Ann Arbor, MI, United States of America
| | - Lance D. Dworkin
- Department of Medicine, University of Toledo College of Medicine and Life Sciences, Toledo, OH, United States of America
| | - Donald E. Cutlip
- Harvard Clinical Research Institute, Boston, MA, United States of America
| | - Timothy P. Murphy
- Departments of Medicine and Diagnostic Imaging, Rhode Island Hospital and Alpert Medical School of Brown University, Providence, RI, United States of America
| | | | - William L. Henrich
- University of Texas Health Science Center, San Antonio TX, United States of America
| | - Jiang Tian
- Department of Medicine, University of Toledo College of Medicine and Life Sciences, Toledo, OH, United States of America
| | - Joseph I. Shapiro
- Joan C. Edwards School of Medicine, Marshall University, Huntington, WV, United States of America
| | - Christopher J. Cooper
- Department of Medicine, University of Toledo College of Medicine and Life Sciences, Toledo, OH, United States of America
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Beladan CC, Geavlete OD, Botezatu S, Postu M, Popescu BA, Ginghina C, Coman IM. Revascularization in a 17-Year-Old Girl with Neurofibromatosis and Severe Hypertension Caused by Renal Artery Stenosis. Tex Heart Inst J 2017; 44:50-54. [PMID: 28265213 DOI: 10.14503/thij-15-5466] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Renal artery stenosis caused by neurofibromatosis is a rare cause of renovascular hypertension. This hypertension can develop during childhood and is one of the leading causes of poor outcome. We report the case of a 17-year-old girl who was incidentally diagnosed with severe hypertension. During her examination for secondary hypertension, we reached a diagnosis of neurofibromatosis type 1 on the basis of a cluster of typical findings: optic nerve glioma, café au lait spots, nodular neurofibromas, and axillary freckling. Renal angiograms revealed a hemodynamically significant left renal artery stenosis (70%). Renal angioplasty with a self-expanding stent was performed one month later for rapidly progressive renal artery stenosis (90%) and uncontrolled blood pressure. Excellent blood pressure control resulted immediately and was maintained as of the 2-year follow-up evaluation. We think that percutaneous transluminal renal angioplasty can be effective in select patients who have neurofibromatosis type 1 and refractory hypertension caused by renal artery stenosis.
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O'Brien TJ, Roghanizad AR, Jones PA, Aardema CH, Robertson JL, Diller TE. The Development of a Thin-Filmed Noninvasive Tissue Perfusion Sensor to Quantify Capillary Pressure Occlusion of Explanted Organs. IEEE Trans Biomed Eng 2017; 64:1631-1637. [PMID: 28113229 DOI: 10.1109/tbme.2016.2615241] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
A new thin-filmed perfusion sensor was developed using a heat flux gauge, thin-film thermocouple, and a heating element. This sensor, termed "CHFT+," is an enhancement of the previously established combined heat flux-temperature (CHFT) sensor technology predominately used to quantify the severity of burns [1]. The CHFT+ sensor was uniquely designed to measure tissue perfusion on explanted organs destined for transplantation, but could be functionalized and used in a wide variety of other biomedical applications. Exploiting the thin and semiflexible nature of the new CHFT+ sensor assembly, perfusion measurements can be made from the underside of the organ-providing a quantitative indirect measure of capillary pressure occlusion. Results from a live tissue test demonstrated, for the first time, the effects of pressure occlusion on an explanted porcine kidney. CHFT+ sensors were placed on top of and underneath 18 kidneys to measure and compare perfusion at perfusate temperatures of 5 and 20 °C. The data collected show a greater perfusion on the topside than the underside of the specimen for the length of the experiment. This indicates that the pressure occlusion is truly affecting the perfusion, and, thus, the overall preservation of explanted organs. Moreover, the results demonstrate the effect of preservation temperature on the tissue vasculature. Focusing on the topside perfusion only, the 20 °C perfusion was greater than the 5 °C perfusion, likely due to the vasoconstrictive response at the lower perfusion temperatures.
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Fatic N, Kuzmanovic I, Markovic D, Davidovic L, Vukovic M, Kostić D. Kidney injury secondary to endovascular treatment of renal artery stenosis. Angiol Sosud Khir 2017; 23:159-163. [PMID: 28594810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
In this paper, we present a case of kidney injury as a complication of renal artery angioplasty in a 54-year-old female patient that suffered from resistant renovascular hypertension. This case emphasises the unpredictable nature of endovascular procedures, the need for careful post-procedure evaluation and the role of 'old fashioned' surgical techniques in resolving complications of endovascular procedures.
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Affiliation(s)
- N Fatic
- Department of vascular surgery, Clinic Center of Montenegro
| | - I Kuzmanovic
- Clinic for vascular and endovascular surgery, Clinic Center of Serbia; Faculty of Medicine, University of Belgrade, Serbia
| | - D Markovic
- Clinic for vascular and endovascular surgery, Clinic Center of Serbia; Faculty of Medicine, University of Belgrade, Serbia
| | - L Davidovic
- Clinic for vascular and endovascular surgery, Clinic Center of Serbia; Faculty of Medicine, University of Belgrade, Serbia
| | - M Vukovic
- Department of vascular surgery, Clinic Center of Montenegro
| | - D Kostić
- Clinic for vascular and endovascular surgery, Clinic Center of Serbia; Faculty of Medicine, University of Belgrade, Serbia
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Abstract
Renal artery disease produces a spectrum of progressive clinical manifestations ranging from minor degrees of hypertension to circulatory congestion and kidney failure. Moderate reductions in renal blood flow do not induce tissue hypoxia or damage, making medical therapy for renovascular hypertension feasible. Several prospective trials indicate that optimized medical therapy using agents that block the renin-angiotensin system should be the initial management. Evidence of progressive disease and/or treatment failure should allow recognition of high-risk subsets that benefit from renal revascularization. Severe reductions in kidney blood flow ultimately activate inflammatory pathways that do not reverse with restoring blood flow alone.
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Affiliation(s)
- Stephen C Textor
- Division of Nephrology and Hypertension, Mayo Clinic, 200 1st Street, Rochester, MN 55905, USA.
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Tuttle KR, Dworkin LD, Henrich W, Greco BA, Steffes M, Tobe S, Shapiro JI, Jamerson K, Lyass A, Pencina K, Massaro JM, D’Agostino RB, Cutlip DE, Murphy TP, Cooper CJ. Effects of Stenting for Atherosclerotic Renal Artery Stenosis on eGFR and Predictors of Clinical Events in the CORAL Trial. Clin J Am Soc Nephrol 2016; 11:1180-1188. [PMID: 27225988 PMCID: PMC4934844 DOI: 10.2215/cjn.10491015] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Accepted: 04/05/2016] [Indexed: 01/09/2023]
Abstract
BACKGROUND AND OBJECTIVES Atherosclerotic renal artery stenosis may cause kidney function loss, but effects of stenting on eGFR and clinical events associated with CKD are uncertain. Our study objectives were to determine effects of stenting on eGFR and predictors of clinical events. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS Participants (n=931) in the Cardiovascular Outcomes in Renal Artery Stenosis Trial (from May of 2005 to September of 2012) had >60% atherosclerotic renal artery stenosis and systolic hypertension on two or more antihypertensive drugs and/or stage ≥3 CKD. The intervention was stenting versus no stenting on a background of risk factor management: renin-angiotensin system inhibition, statin, antiplatelet therapy, and smoking cessation education. The effect of stenting on eGFR by the serum creatinine-cystatin C Chronic Kidney Disease Epidemiology Collaboration equation was the prespecified analysis of kidney function. Predictors of eGFR and CKD outcomes (≥30% eGFR loss, ESRD, and death) and cardiovascular disease outcomes (stroke, myocardial infarction, heart failure, and death) controlling for eGFR and albuminuria were also determined. RESULTS eGFR was 59±24 ml/min per 1.73 m(2) (mean±SD) at baseline. Over 3 years, eGFR change, assessed by generalized estimating equations, was -1.5±7.0 ml/min per 1.73 m(2) per year in the stent group versus -2.3±6.3 ml/min per 1.73 m(2) per year in the medical therapy only group (P=0.18). eGFR predictors (multiple variable generalized estimating equations) were age, albuminuria, systolic BP, and diabetes (inverse associations) as well as men, total cholesterol, and HDL cholesterol (positive associations). CKD outcomes events occurred in 19% (175 of 931), and predictors (Cox proportional hazards models) included albuminuria (positive association), systolic BP (positive association), and HDL cholesterol (inverse association). Cardiovascular disease outcomes events occurred in 22% (207 of 931), and predictors included age, albuminuria, total cholesterol, prior cardiovascular disease, and bilateral atherosclerotic renal artery stenosis (positive associations). CONCLUSIONS Stenting did not influence eGFR in participants with atherosclerotic renal artery stenosis receiving renin-angiotensin system inhibition-based therapy. Predictors of clinical events were traditional risk factors for CKD and cardiovascular disease.
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Affiliation(s)
| | - Lance D. Dworkin
- Brown University, Providence, Rhode Island
- Rhode Island Hospital, Providence, Rhode Island
| | - William Henrich
- University of Texas Health Science Center, San Antonio, Texas
| | | | | | | | | | | | - Asya Lyass
- Harvard Clinical Research Institute, Boston University, Boston, Massachusetts
| | - Karol Pencina
- Harvard Clinical Research Institute, Boston University, Boston, Massachusetts
| | - Joseph M. Massaro
- Harvard Clinical Research Institute, Boston University, Boston, Massachusetts
| | - Ralph B. D’Agostino
- Harvard Clinical Research Institute, Boston University, Boston, Massachusetts
| | - Donald E. Cutlip
- Beth Israel Deaconess Medical Center, Boston, Massachusetts; and
| | - Timothy P. Murphy
- Brown University, Providence, Rhode Island
- Rhode Island Hospital, Providence, Rhode Island
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Zähringer M, Sapoval M, Pattynama PMT, Rabbia C, Vignali C, Maleux G, Boyer L, Szczerbo-Trojanowska M, Jaschke W, Hafsahl G, Downes M, Bérégi JP, Veeger NJGM, Stoll HP, Talen A. Sirolimus-Eluting versus Bare-Metal Low-Profile Stent for Renal Artery Treatment (GREAT Trial): Angiographic Follow-up after 6 Months and Clinical Outcome up to 2 Years. J Endovasc Ther 2016; 14:460-8. [PMID: 17696619 DOI: 10.1177/152660280701400405] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Purpose: To evaluate the patency of sirolimus-eluting stents (SES) compared to bare-metal stents (BMS) in the treatment of atherosclerotic renal artery stenosis (RAS). Methods: Between November 2001 to June 2003, 105 consecutive symptomatic patients (53 men; mean age 65.7 years) with RAS were treated with either a bare-metal (n=52) or a drug-eluting (n=53) low-profile Palmaz-Genesis peripheral stent at 11 centers in a prospective nonrandomized trial. The primary endpoint was the angiographic result at 6 months measured with quantitative vessel analysis by an independent core laboratory. Secondary endpoints were technical and procedural success, clinical patency [no target lesion revascularization (TLR)], blood pressure and antihypertensive drug use, worsening of renal function, and no major adverse events at 1, 6, 12, and 24 months. Results: At 6 months, the overall in-stent diameter stenosis for BMS was 23.9%±22.9% versus 18.7%±15.6% for SES (p=0.39). The binary restenosis rate was 6.7% for SES versus 14.6% for the BMS (p=0.30). After 6 months and 1 year, TLR rate was 7.7% and 11.5%, respectively, in the BMS group versus 1.9% at both time points in the SES group (p=0.21). This rate remained stable up to the 2-year follow-up but did not reach significance due to the small sample. Even as early as 6 months, both types of stents significantly improved blood pressure and reduced antihypertensive medication compared to baseline (p<0.01). After 6 months, renal function worsened in 4.6% of the BMS patients and in 6.9% of the SES group. The rate of major adverse events was 23.7% for the BMS group and 26.8% for the SES at 2 years (p=0.80). Conclusion: The angiographic outcome at 6 months did not show a significant difference between BMS and SES. Renal artery stenting with both stents significantly improved blood pressure. Future studies with a larger patient population and longer angiographic follow-up are warranted to determine if there is a significant benefit of drug-eluting stents in treating ostial renal artery stenosis.
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Bae EH, Ma SK, Kim SS, Kang HC, Kim SW. Renal artery compression by a huge pheochromocytoma. Korean J Intern Med 2016; 31:622-3. [PMID: 26911994 PMCID: PMC4855103 DOI: 10.3904/kjim.2015.222] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Revised: 07/24/2015] [Accepted: 07/28/2015] [Indexed: 11/27/2022] Open
Affiliation(s)
- Eun Hui Bae
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Seong Kwon Ma
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Sung Sun Kim
- Department of Pathology, Chonnam National University Medical School, Gwangju, Korea
| | - Ho-Cheol Kang
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Soo Wan Kim
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
- Correspondence to Soo Wan Kim M.D. Tel: +82-62-220-6271 Fax: +82-62-225-8578 E-mail:
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Phillips AR, Eliason JL, Stanley JC, Coleman DM. Infantile Renovascular Hypertension with Failure to Thrive. Ann Vasc Surg 2016; 33:227.e5-8. [PMID: 26965798 DOI: 10.1016/j.avsg.2015.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Revised: 10/08/2015] [Accepted: 12/02/2015] [Indexed: 11/18/2022]
Abstract
Severe hypertension in infancy is a rare cause of failure to thrive. The successful surgical management of this disease in an infant having refractory renovascular hypertension and growth failure is reported.
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Affiliation(s)
- Amanda R Phillips
- Section of Vascular Surgery, University of Michigan Frankel Cardiovascular Center, Ann Arbor, MI
| | - Jonathan L Eliason
- Section of Vascular Surgery, University of Michigan Frankel Cardiovascular Center, Ann Arbor, MI
| | - James C Stanley
- Section of Vascular Surgery, University of Michigan Frankel Cardiovascular Center, Ann Arbor, MI
| | - Dawn M Coleman
- Section of Vascular Surgery, University of Michigan Frankel Cardiovascular Center, Ann Arbor, MI.
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Lenz T, Schulte KL. Current management of renal artery stenosis. Panminerva Med 2016; 58:94-101. [PMID: 26730463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Severe renal artery stenosis may cause renovascular hypertension; in case of bilateral narrowing or in a stenotic solitary kidney, renal insufficiency (e.g. ischemic kidney disease) or pulmonary flash edema may ensue. Renal artery stenosis can be treated by revasularization, using either percutaneous angioplasty (with or without stenting) or less common open surgical procedures, both with excellent primary patency rates. However, several randomized trials of renal artery angioplasty or stenting in patients with arteriosclerotic disease have failed to demonstrate a longer-term benefit with regard to blood pressure control and renal function over medical management. It has not yet been demonstrated that renal revascularization leads to a prolongation of event-free survival. Furthermore, endovascular procedures are associated with substantial risks. If revascularization is envisaged careful patient selection, e.g. patients with refractory hypertension or progressive renal failure, is important to maximize the potential benefit.
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Affiliation(s)
- Tomas Lenz
- KfH Kidney Center & IPNH, Ludwigshafen, Germany -
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Mousa AY, AbuRahma AF, Bozzay J, Broce M, Bates M. Update on intervention versus medical therapy for atherosclerotic renal artery stenosis. J Vasc Surg 2015; 61:1613-23. [PMID: 26004332 DOI: 10.1016/j.jvs.2014.09.072] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Accepted: 09/09/2014] [Indexed: 11/16/2022]
Abstract
Atherosclerotic renal artery stenosis is known to be one of the most common causes of secondary hypertension, and early nonrandomized studies suggested that renal artery stenting (RASt) improved outcomes. The vascular community embraced this less invasive treatment alternative to surgery, and RASt increased in popularity during the late 1990s. However, recent randomized studies have failed to show a benefit regarding blood pressure or renal function when RASt was compared with best medical therapy, creating significant concerns about procedural efficacy. In the wake of these randomized trial results, hypertension and renal disease experts along with vascular interventional specialists now struggle with how to best manage atherosclerotic renal artery stenosis. This review objectively analyzes the current literature and highlights each trial's design weaknesses and strengths. We have provided our recommendations for contemporary treatment guidelines based on our interpretation of the available empirical data.
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Affiliation(s)
- Albeir Y Mousa
- Department of Surgery, West Virginia University, Charleston, WVa.
| | - Ali F AbuRahma
- Department of Surgery, West Virginia University, Charleston, WVa
| | - Joseph Bozzay
- Department of Surgery, West Virginia University, Charleston, WVa
| | - Mike Broce
- CAMC Health Education and Research Institute, Charleston, WVa
| | - Mark Bates
- Department of Surgery, West Virginia University, Charleston, WVa
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Conti F, Ceccarelli F, Gigante A, Perricone C, Barbano B, Massaro L, Spinelli FR, Alessandri C, Valesini G, Cianci R. Ultrasonographic Evaluation of Resistive Index and Renal Artery Stenosis in Patients with Anti-Phospholipid Syndrome: Two Distinct Mechanisms? Ultrasound Med Biol 2015; 41:1814-1820. [PMID: 25800790 DOI: 10.1016/j.ultrasmedbio.2015.02.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Revised: 02/16/2015] [Accepted: 02/19/2015] [Indexed: 06/04/2023]
Abstract
Renal involvement in anti-phospholipid syndrome (APS) is still relatively unknown and probably underestimated. The described lesions consist of renal artery stenosis (RAS), venous renal thrombosis and glomerular lesions. The resistive index (RI) of intra-renal arteries, expression of the degree of vascular resistance, has been analyzed in different nephropathies and observed to be associated with functional parameters and some histologic features. In contrast, there are no studies on patients with APS. We evaluated the presence of a pathologic RI and RAS in a cohort of patients with APS. The study protocol included ultrasonographic assessment to measure the RI (RIs >0.7 were considered pathologic) and to determine the presence of RAS. We enrolled 36 patients with APS, 13 with primary APS and 23 with the form associated with systemic lupus erythematosus (SLE, secondary APS). As controls, we enrolled 10 anti-phospholipid antibody carriers, 10 patients with SLE without renal involvement and 14 age- and sex-matched healthy patients. A pathologic RI was identified in five patients with APS (13.9%) and in none of the anti-phospholipid antibody carriers (p = 0.00007). Four of the five (80%) patients with a pathologic RI had secondary APS. Three patients, all with primary APS, had RAS. The almost exclusive association of a pathologic RI with secondary APS and of RAS with primary APS suggests the involvement of two pathogenic pathways in the development of these different manifestations. The hypercoagulability status driven by APS could play a central role in the determination of RAS in patients with primary APS, whereas the activation of mTORC (mammalian target of rapamycin complex) pathways could be the pathogenic mechanism inducing development of a pathologic RI.
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Affiliation(s)
- Fabrizio Conti
- Lupus Clinic, Rheumatology Unit, Department of Internal Medicine and Medical Specialties, Sapienza University of Rome, Rome, Italy.
| | - Fulvia Ceccarelli
- Lupus Clinic, Rheumatology Unit, Department of Internal Medicine and Medical Specialties, Sapienza University of Rome, Rome, Italy
| | - Antonietta Gigante
- Department of Clinical Medicine, Sapienza University of Rome, Rome, Italy
| | - Carlo Perricone
- Lupus Clinic, Rheumatology Unit, Department of Internal Medicine and Medical Specialties, Sapienza University of Rome, Rome, Italy
| | - Biagio Barbano
- Department of Clinical Medicine, Sapienza University of Rome, Rome, Italy
| | - Laura Massaro
- Lupus Clinic, Rheumatology Unit, Department of Internal Medicine and Medical Specialties, Sapienza University of Rome, Rome, Italy
| | - Francesca Romana Spinelli
- Lupus Clinic, Rheumatology Unit, Department of Internal Medicine and Medical Specialties, Sapienza University of Rome, Rome, Italy
| | - Cristiano Alessandri
- Lupus Clinic, Rheumatology Unit, Department of Internal Medicine and Medical Specialties, Sapienza University of Rome, Rome, Italy
| | - Guido Valesini
- Lupus Clinic, Rheumatology Unit, Department of Internal Medicine and Medical Specialties, Sapienza University of Rome, Rome, Italy
| | - Rosario Cianci
- Department of Clinical Medicine, Sapienza University of Rome, Rome, Italy
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Lantelme P, Harbaoui B, Courand PY. [Renal artery stenosis]. Rev Prat 2015; 65:822-826. [PMID: 26298908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Renal artery stenosis (RAS) is found in 1 to 2% of all hypertensive patients. Its diagnosis involves as a first step Doppler ultrasound and as a confirmatory test, CT scan or MRI. When the diagnosis isconfirmed, three questions should be addressed by the clinician: 1) the anatomical orm that is, fibromuscular dysplasia (FD) or atherosclerotic RAS (ARAS); 2) the potential relation between RAS and hypertension with major differences according to the two main etiologies; in the presence of FD hypertension is a priorir elated to the stenosis while it is not the case with ARAS; 3) is there an indication for revascularization with again two opposite situations. Renal angioplasty may cure up to one third of patients with FD and improve blood pressure control in some others and has thus to be discussed in this clinical context. On the contrary, several randomized trials have shown that the blood pressure benefit of renal revascularization is limited if any in ARAS and, above all, not associated with an improvement of cardiovascular and renal outcomes. Renal angioplasty should thus be restricted to highly selected patients while in all cases, cardiovascular prevention should be intensified, based on renin angiotensin system blockers, statins, and aspirin use. Whatever the management, these patients should be followed both on the renal side to detect restenosis or renal impairment, and on other cardiovascular complications particularly in the presence of ARAS.
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Sun A, Tian X, Zhang N, Xu Z, Deng X, Liu M, Liu X. Does lower limb exercise worsen renal artery hemodynamics in patients with abdominal aortic aneurysm? PLoS One 2015; 10:e0125121. [PMID: 25946196 PMCID: PMC4422666 DOI: 10.1371/journal.pone.0125121] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Accepted: 03/20/2015] [Indexed: 11/19/2022] Open
Abstract
Renal artery stenosis (RAS) and renal complications emerge in some patients after endovascular aneurysm repair (EVAR) to treat abdominal aorta aneurysm (AAA). The mechanisms for the causes of these problems are not clear. We hypothesized that for EVAR patients, lower limb exercise could negatively influence the physiology of the renal artery and the renal function, by decreasing the blood flow velocity and changing the hemodynamics in the renal arteries. To evaluate this hypothesis, pre- and post-operative models of the abdominal aorta were reconstructed based on CT images. The hemodynamic environment was numerically simulated under rest and lower limb exercise conditions. The results revealed that in the renal arteries, lower limb exercise decreased the wall shear stress (WSS), increased the oscillatory shear index (OSI) and increased the relative residence time (RRT). EVAR further enhanced these effects. Because these parameters are related to artery stenosis and atherosclerosis, this preliminary study concluded that lower limb exercise may increase the potential risk of inducing renal artery stenosis and renal complications for AAA patients. This finding could help elucidate the mechanism of renal artery stenosis and renal complications after EVAR and warn us to reconsider the management and nursing care of AAA patients.
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Affiliation(s)
- Anqiang Sun
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Xiaopeng Tian
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Nan Zhang
- Radiologic Department, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Zaipin Xu
- College of Animal Science, Guizhou University, Guiyang, China
| | - Xiaoyan Deng
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Ming Liu
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Xiao Liu
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
- * E-mail:
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Missouris CG, MacGregor GA. New thoughts and unsolved problems in atheromatous renovascular disease. Contrib Nephrol 2015; 119:39-44. [PMID: 8783589 DOI: 10.1159/000425447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- C G Missouris
- Department of Medicine, St. George's Hospital Medical School, London, UK
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Zuccalà A, Losinno F, Gaggi R, Zucchelli P. Late improvement of renal function in patients treated by percutaneous transluminal renal angioplasty. Contrib Nephrol 2015; 119:74-7. [PMID: 8783594 DOI: 10.1159/000425452] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- A Zuccalà
- Divisione di Nefrologia, Policlinico S. Orsola-Malpighi, Bologna, Italia
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Morganti A. Renal angioplasty: morphological and pathophysiological aspects. Contrib Nephrol 2015; 69:87-94. [PMID: 2525456 DOI: 10.1159/000416750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- A Morganti
- Istituto di Clinica Medica Generale e Terapia Medica, Università di Milano, Italia
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Liang Z, Shi XM, Liu LF, Chen XP, Shan ZL, Lin K, Li J, Chen FK, Li YG, Guo HY, Wang YT. Renal denervation suppresses atrial fibrillation in a model of renal impairment. PLoS One 2015; 10:e0124123. [PMID: 25884946 PMCID: PMC4401704 DOI: 10.1371/journal.pone.0124123] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Accepted: 02/26/2015] [Indexed: 12/22/2022] Open
Abstract
Background A close association exists between renal impairment (RI) and atrial fibrillation (AF) occurrence. Increased activity of the sympathetic nervous system (SNS) may contribute to the development of AF associated with RI. Renal denervation (RDN) decreases central sympathetic activity. Objective The main objective of the study was to explore the effects of RDN on AF occurrence and its possible mechanisms in beagles with RI. Methods Unilateral RI was induced in beagles by embolization of small branches of the renal artery in the right kidney using gelatin sponge granules in Model (n = 6) and RDN group (n = 6). The Sham group (n = 6) underwent the same procedure, except for embolization. Then animals in RDN group underwent radiofrequency ablation of the renal sympathetic nerve. Cardiac electrophysiological parameters, blood pressure, left ventricular end-diastolic pressure, and AF inducibility were investigated. The activity of the SNS, renin-angiotensin-aldosterone system (RAAS), inflammation and atrial interstitial fibrosis were measured. Results Embolization of small branches of the renal artery in the right kidney led to ischemic RI. Heart rate, P wave duration and BP were increased by RI, which were prevented or attenuated by RDN. Atrial effective refractory period was shortened and AF inducibility was increased by RI, which were prevented by RDN. Antegrade Wenckebach point was shortened, atrial and ventricular rates during AF were increased by RI, which were attenuated or prevented by RDN. Levels of norepinephrine, renin and aldosterone in plasma, norepinephrine, angiotensin II, aldosterone, interleukin-6 and high sensitivity C-reactive protein in atrial tissue were elevated, and atrial interstitial fibrosis was enhanced by RI, which were attenuated by RDN. Conclusions RDN significantly reduced AF inducibility, prevented the atrial electrophysiological changes in a model of RI by combined reduction of sympathetic drive and RAAS activity, and inhibition of inflammation activity and fibrotic pathway in atrial tissue.
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Affiliation(s)
- Zhuo Liang
- Department of Cardiology, Chinese PLA General Hospital, Beijing, China
| | - Xiang-min Shi
- Department of Cardiology, Chinese PLA General Hospital, Beijing, China
| | - Li-feng Liu
- Department of Cardiology, Chinese PLA General Hospital, Beijing, China
| | - Xin-pei Chen
- Department of Emergency, Beijing Tsinghua Changgeng Hospital Medical Center, Tsinghua University, Beijing, China
| | - Zhao-liang Shan
- Department of Cardiology, Chinese PLA General Hospital, Beijing, China
| | - Kun Lin
- Department of Cardiology, Chinese PLA General Hospital, Beijing, China
| | - Jian Li
- Department of Geriatric Cardiology, Chinese PLA General Hospital, Beijing, China
| | - Fu-kun Chen
- Department of Cardiology, Chinese PLA General Hospital, Beijing, China
| | - Yan-guang Li
- Department of Cardiology, Chinese PLA General Hospital, Beijing, China
| | - Hong-yang Guo
- Department of Cardiology, Chinese PLA General Hospital, Beijing, China
| | - Yu-tang Wang
- Department of Geriatric Cardiology, Chinese PLA General Hospital, Beijing, China
- * E-mail:
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Brown JJ, Cuesta V, Davies DL, Lever AF, Morton JJ, Padfield PL, Robertson JI, Trust P, Bianchi G, Schalekamp MA. Can angiotensin II cause renal hypertension when its plasma concentration is normal? Contrib Nephrol 2015; 8:57-60. [PMID: 891218 DOI: 10.1159/000400614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Abstract
Three types of renal hypertension in the rat have been compared with respect to blood pressure increase, activity of the RAS, and secretion of aldosterone and corticosterone: type I - unilateral stenosis of the renal artery in the presence of an intact contralateral kidney; type II - unilateral stenosis of the renal artery after contralateral nephrectomy; type III - bilateral stenosis of the renal arteries. Blood pressure rose more rapidly and reached higher values in type II and type III hypertension than in type I hypertension. In the latter group, the activity of the RAS was more stimulated than in types II and III. The marked stimulation of the RAS in type I hypertension is ascribed to the negative fluid and sodium balance, which is the consequence of a pressure-induced diuresis of the unclamped contralateral kidney. Suppression of the activity of the RAS by a 4-week pretreatment with DOC-TMA and saline or by the administration of DOCA and saline as from the induction of renal artery stenosis did not prevent the development of hypertension caused by the clamping of one renal artery (type I). In spontaneously hypertensive rats of the stroke-prone substrain, high dietary salt intake caused higher blood pressure values and a higher incidence of cerebral lesions than normal dietary salt intake. Low salt intake was followed by a marked stimulation of the RAS, but blood pressure rose only slightly and no symptoms of cerebrovascular lesions were observed. It is concluded that neither in hypertension induced by renal artery stenosis nor in spontaneously hypertensive rats, the RAS contributes significantly to the increase in blood pressure nor does it play a major part in the pathogenesis of vascular lesions. These seem to be related to the retention of sodium, which may be obtained by renal artery stenosis, by excessive salt intake, or by the administration of a mineralocorticoid and salt.
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Abstract
Determinants of glomerular ultrafiltration were studied by micropuncture in clamped (n = 11) and unclamped (n = 7) kidneys of two-kidney hypertensive rats and compared to 15 controls. Infusion of the angiotensin II antagonist and saralasin lowered the blood pressure significantly. Glomerular capillary pressure (PGC) in clamped kidneys was decreased to 56 +/- (SD) 3 vs. 61 +/- 3 mm Hg in controls. Early proximal flow rate (EPFR) was decreased to 20 +/- 1 vs. 26 +/- 2 nl/min in controls, at an unchanged single nephron filtration fraction (SNFF), indicating a reduced glomerular plasma flow (SNGPF). Preglomerular resistance (RA) was increased by 21%. In unclamped kidneys PGC was increased to 65 +/- 2 mm Hg. EPFR was increased to 32 +/- 2 nl/min, indicating, at an unchanged SNFF, an increased SNGPF. RA increased by 51%, whereas postglomerular resistance declined by 25%. The ultrafiltration coefficient was reduced by 24% in unclamped kidneys. Our results indicate that in clamped kidneys an increase of RA causes a reduction of PGC and hence a reduction of pressure at the baroreceptor site which may act as a trigger mechanism for renin release.
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