Atherosclerotic Renal Stenosis Research Articles

Is stenting for atherosclerotic renal stenosis an effective technique?

IntroductionOne of the treatments for renal artery stenosis is endovascular intervention, but its effectiveness is controversial. The present study aims to analyze the experience of a working group in the endovascular treatment of selected patients with severe obstructive atherosclerotic lesions of the renal arteries, and to characterize early and late results. MethodsThis is a retrospective study of symptomatic patients with atherosclerotic renal artery stenosis who underwent endoluminal therapy between May 12, 1999 and March 12, 2015 at two institutions. Statistical analysis was performed using the PASW Statistics program. ResultsA total of 99 patients were treated, mean age 66 years and 76.8% male. The mean degree of stenosis measured by renal Doppler echocardiography was 83% and 64.6% were ostial lesions. Mean preoperative creatinine level was higher than the postoperative mean: 1.3 vs. 1.2 mg/dl (p=0.014). The number of antihypertensive drugs in the preoperative period was higher than in the postoperative period: 2.0 vs. 1.3 (p=0.001). The mean follow-up was 40 months (0-164). The mean peak systolic velocity over time in the postoperative period was 77 cm/s (40-250). The restenosis rate was 8%, and 30-day mortality was 0%. ConclusionsThe results demonstrated that the endovascular technique has a beneficial effect on blood pressure and renal function in selected patients, and is a safe technique associated with a high rate of technical success and few complications.

Is stenting for atherosclerotic renal stenosis an effective technique?

One of the treatments for renal artery stenosis is endovascular intervention, but its effectiveness is controversial. The present study aims to analyze the experience of a working group in the endovascular treatment of selected patients with severe obstructive atherosclerotic lesions of the renal arteries, and to characterize early and late results. This is a retrospective study of symptomatic patients with atherosclerotic renal artery stenosis who underwent endoluminal therapy between May 12, 1999 and March 12, 2015 at two institutions. Statistical analysis was performed using the PASW Statistics program. A total of 99 patients were treated, mean age 66 years and 76.8% male. The mean degree of stenosis measured by renal Doppler echocardiography was 83% and 64.6% were ostial lesions. Mean preoperative creatinine level was higher than the postoperative mean: 1.3 vs. 1.2 mg/dl (p=0.014). The number of antihypertensive drugs in the preoperative period was higher than in the postoperative period: 2.0 vs. 1.3 (p=0.001). The mean follow-up was 40 months (0-164). The mean peak systolic velocity over time in the postoperative period was 77 cm/s (40-250). The restenosis rate was 8%, and 30-day mortality was 0%. The results demonstrated that the endovascular technique has a beneficial effect on blood pressure and renal function in selected patients, and is a safe technique associated with a high rate of technical success and few complications. Um dos tratamentos da estenose das artérias renais é a intervenção endovascular sendo a sua eficácia controversa. O presente estudo tem como objetivo analisar a experiência de um grupo de trabalho no tratamento endovascular de doentes selecionados com lesões obstrutivas ateroscleróticas graves das artérias renais, procurando caracterizar os resultados precoces e tardios. Trata-se de um estudo retrospetivo de doentes com lesões ateroscleróticas das artérias renais, sintomáticos, submetidos a terapêutica endoluminal, de 12 de maio de 1999 a 12 de março de 2015 em duas instituições. A análise estatística foi realizada com o programa PASW Statistics. Foram tratados 99 doentes com média de 66 anos e 76,8% homens. O grau de estenose médio foi de 83% medido através do ecodoppler renal sendo 64,6% das lesões ostiais. A média de creatinina no pré-operatório foi superior à média do pós-operatório: 1,3 versus 1,2 (p=0,014). O número de fármacos anti-hipertensores no pré-operatório foi superior ao do pós-operatório: 2,0 versus 1,3, (p=0,001). A média de follow-up foi de 40 meses [0-164]. A velocidade sistólica média ao longo do tempo no pós-operatório foi de 77 [40-250]. A taxa de re-estenose foi de 8% e a mortalidade aos 30 dias foi de 0%. Os resultados obtidos demonstraram que a técnica endovascular exibe um efeito benéfico ao nível da tensão arterial e função renal num determinado grupo de doentes sendo uma técnica segura associada a uma taxa elevada de sucesso técnico e baixa de complicações.

Optimal Medical Management in Patients with Renovascular Hypertension

Renovascular hypertension refers to the rise of arterial pressure due to reduced perfusion of the kidney caused by the stenotic renal artery/ies. The most common cause of stenotic renal artery is atherosclerosis. Atherosclerotic renal stenosis is usually part of a systemic syndrome that involves hypertension, intrinsic renal damage, and cardiovascular morbidity. So far, large trials have not proven the superiority of interventional therapies to medical management. As a result, renal artery stenosis should be treated mainly as a coronary artery disease equivalent focusing on rigorous management of hypertension, hyperglycemia, and hyperlipidemia. Antihypertensive treatment should include renin-angiotensin system blockade medication in most cases, while HMG-CoA reductase inhibitors (statins) can be used even in chronic kidney disease with safety. Lifestyle modifications, such as cessation of smoking, and antiplatelet therapy have reduced the risk of cardiovascular events in high-risk patients.

Stent revascularization for the prevention of cardiovascular and renal events among patients with renal artery stenosis and systolic hypertension: Rationale and design of the CORAL trial

Atherosclerotic renal artery stenosis is a problem with no consensus on diagnosis or therapy. The consequences of renal ischemia are neuroendocrine activation, hypertension, and renal insufficiency that can potentially result in acceleration of atherosclerosis, further renal dysfunction, myocardial infarction, heart failure, stroke, and death. Whether revascularization improves clinical outcomes when compared with optimum medical therapy is unknown. CORAL is a randomized clinical trial contrasting optimum medical therapy alone to stenting with optimum medical therapy on a composite cardiovascular and renal end point: cardiovascular or renal death, myocardial infarction, hospitalization for congestive heart failure, stroke, doubling of serum creatinine, and need for renal replacement therapy. The secondary end points evaluate the effectiveness of revascularization in important subgroups of patients and with respect to all-cause mortality, kidney function, renal artery patency, microvascular renal function, and blood pressure control. We will also correlate stenosis severity with longitudinal renal function and determine the value of stenting from the perspectives of quality of life and cost-effectiveness. The primary entry criteria are (1) an atherosclerotic renal stenosis of > or = 60% with a 20 mm Hg systolic pressure gradient or > or = 80% with no gradient necessary and (2) systolic hypertension of > or = 155 mm Hg on > or = 2 antihypertensive medications. Randomization will occur in 1080 subjects. The study has 90% power to detect a 28% reduction in primary end point hazard rate. CORAL represents a unique opportunity to determine the incremental value of stent revascularization, in addition to optimal medical therapy, for the treatment of atherosclerotic renal artery stenosis.

Time course of inflammatory response after renal artery stenting in patients with atherosclerotic renal stenosis

Background Inflammatory response has been demonstrated in patients with coronary artery disease after percutaneous coronary intervention (PCI). Such response following renal artery stenting has not yet been established, however, in patients with atherosclerotic renal artery stenosis. Methods A total of 44 patients were enrolled in this study. Of them, 22 patients with atherosclerotic renal artery stenosis received renal angioplasty with stent (group A, mean age 51±8 years), and 22 patients with age- and gender-matched underwent renal angiography for diagnostic purpose as a control group (group B, age 50±8 years). The peripheral blood samples were taken immediately before the procedure, 1, 6 and 24 h after the procedure in both groups. The concentrations of C-reactive protein (CRP) and interleukin-6 (IL-6) were measured using ELISA. Results The result showed that there was no difference in clinical characteristics and baseline levels of CRP and IL-6 between the groups. The IL-6 increased in the first hour (before: 5.8±3 pg/ml; 1 h: 8.6±5 pg/ml, p<0.01), lasted at 6 h (12.2±8 pg/ml), returned to baseline at 24 h (5.4±3 pg/ml) in group A. The CRP did not changed at the first hour after stenting, but mean CRP increased from 0.30±0.09 to 0.37±0.15 mg/dl at 6 h ( p<0.05), and peaked at 24 h (0.43±0.18 mg/dl, p<0.001 compared with baseline and control) after stenting in group A, while no such changes were observed in group B ( p>0.05 at different time points compared with baseline and group B, respectively). Conclusions The data indicated that renal artery stenting could trigger inflammatory response by evidence of increased plasma levels of CRP and IL-6. IL-6, however, was an early initiator of inflammatory cytokine, and CRP was a later marker of systemic inflammatory response to renal artery stenting.

Atherosclerotic nephropathy

Lipid moieties may have direct or indirect effects on the kidney. The association of aortic atherosclerosis and renal artery stenosis has focused interest on this as an important cause of end-stage renal failure. This article seeks to examine the evidence for the entity of atherosclerotic nephropathy. Published data on the incidence of atherosclerotic renal artery stenosis as the cause of end-stage renal failure are presented, as well as the associated features of atherosclerotic renal stenosis. Atherosclerotic renal artery stenosis (ARAS) has been estimated to be the cause of between 14 and 25% of patients reaching end-stage renal failure in older age groups. There is considerable evidence of proteinuria in patients with ARAS. Recent data have shown that renal length may decrease by 1 cm or more in 35% of kidneys with > 60% stenosis. However, other data suggest that renal function in kidneys without renal artery stenosis but with contralateral renal artery stenosis may be similarly decreased. Many processes contribute to renal dysfunction in atherosclerotic aortic disease. Although ischemia may play a role, there is considerable evidence that processes such as atheroembolic disease may be important, and it would be better to use the term "atherosclerotic nephropathy" for this important disease entity.