Ischemic nephropathy: Recognition and treatment

Abstract

Atherosclerotic renal artery stenosis (RAS) is a progressive disorder and an increasing cause of renal function impairment. Ischemic nephropathy is responsible for up to 22% of patients over the age of 50 years with renal insufficiency, and 16.5% of patients presenting for hemodialysis. Because medical therapy does not affect the progressive nature of this process, an aggressive approach in diagnosis and definitive treatment of RAS in patients with renal insufficiency should be adopted. Once RAS is confirmed in this patient population, revascularization is indicated. Percutaneous transluminal renal angioplasty and/or stenting has been shown to improve or stabilize renal function in 80% of patients, and should be considered the primary treatment for patients with this condition. Procedural imaging using carbon dioxide and gadolinum reduces the risk of nephrotoxicity associated with traditional iodinated contrasts. Atherosclerotic renal artery stenosis (RAS) is a progressive disorder and an increasing cause of renal function impairment. Ischemic nephropathy is responsible for up to 22% of patients over the age of 50 years with renal insufficiency, and 16.5% of patients presenting for hemodialysis. Because medical therapy does not affect the progressive nature of this process, an aggressive approach in diagnosis and definitive treatment of RAS in patients with renal insufficiency should be adopted. Once RAS is confirmed in this patient population, revascularization is indicated. Percutaneous transluminal renal angioplasty and/or stenting has been shown to improve or stabilize renal function in 80% of patients, and should be considered the primary treatment for patients with this condition. Procedural imaging using carbon dioxide and gadolinum reduces the risk of nephrotoxicity associated with traditional iodinated contrasts.