EVALUATION OF THE INFLUENCE OF RENAL CYSTS ON THE LEVEL OF ARTERIAL PRESSURE REDUCTION AFTER RENAL DENERVATION IN PATIENTS WITH RESISTANT HYPERTENSION. THE BIENNIAL INSPECTION

Abstract

Aim. We evaluated the influence of renal cysts on the efficiency of reduction of arterial pressure in patients with treatment-resistant hypertension after renal denervation. Materials and Methods. A total of 33 patients (aged 57.8±8.75 years) with treatment-resistant hypertension were included. All patients underwent radiofrequency ablation (RFA) of the sympathetic nerves of renal arteries. The average level of arterial pressure was as high as 137–210/57–148 mm Hg according to 24-h monitoring. MRI studies were performed using MRI scanner “Titan Vantage” (by Toshiba Medical Ltd., 1.5 Т) in T1-W and T2-W spin-echo models. After this, the intravenous contrast enhancement was carried out (with 0.5 М solution, 0.2 ml/Kg), with subsequently repeated acquisition of Т1-weighted spin-echo images 3-5 min after contrast injection, employing exactly the same protocols as before enhancement. Results. Preoperative images demonstrated cysts in kidneys in half of patients (16 individuals). Positive effect (the arterial pressure decreased by 10 mm Hg) was observed in 70% of them. However, in 30% of population, the arterial pressure increased. Among the patients without cysts in the kidneys, negative effect was observed in 8% only, and positive effect was found in 77% of patients (arterial pressure decreased by over 20 mm Hg). Conclusion. There is a statistically significant trend towards a greater antihypertensive effect of renal denervation in patients without cystic changes in the renal parenchyma (cortex). Thus, MRI is of prognostic value for prediction of renal denervation efficacy.