Оценка показателей расчетной скорости клубочковой фильтрации до и после эндоваскулярной коррекции стеноза почечных артерий на фоне резистентной вазоренальной артериальной гипертензии

Abstract

Atherosclerotic stenosis of the renal arteries is the most common cause of renovascular hypertension (RVHT) among middle-aged and elderly people. In this survey a comparative analysis of the calculated glomerular filtration rate (cGFR) in a patient with resistant renovascular hypertension (RVHT) before and after endovascular correction of atherosclerotic renal artery stenosis is given. The medical records (medical history) of 44 patients (34 men, 10 women) with RVHT were analyzed. The criterion for inclusion in the study was renal artery stenosis of more than 75% of the vessel diameter. The mean age of the patients was 50.7±7.2 years. All patients had unilateral lesion of the renal arteries. Patients were divided into three groups according to the initial level of cGFR. The patients were divided into three groups according to initial cGFR value: Group 1 included 12 patients with cGFR over 90 ml/min/1.73 m2, Group 2 — 19 patients with cGFR from 89 to 60 ml/min/1.73 m2, Group 3 — 13 patients with cGFR from 59 to 45 ml/min/1.73 m2. It was revealed that the level of blood pressure after endovascular correction of stenosis decreased significantly among all patients. At the same time, among the patients with initially preserved cGFR (from 90 ml/min/1.73 m2 and more), there was an improvement in the functional state of the kidneys, a decrease in the number of antihypertensive drugs from 3–5 to a 3-component regimen. Among the patients with initially minimally reduced cGFR (less than 90 ml/min/1.73 m2), the functional state of the kidneys did not change, and among the patients with cGFR less than 60 ml/min/1.73 m2, this state continued to worsen progressively; antihypertensive therapy did not change. During the 2-year follow-up period, restenosis of the renal arteries according to duplex scanning was not observed. When deciding whether to perform endovascular interventions for atherosclerotic stenosis of the renal arteries, it is advisable to take into account the calculated GFR data.