Different outcomes of atherosclerotic renal artery stenosis managed with stenting: results from a cohort study.

Background: To determine whether the type of renal artery stenosis and the rapid decline of renal function may have an impact on renal outcome after stenting.

Methods: Thirty patients with chronic kidney disease stages 3-4 and renal artery stenosis underwent stenting. The mean follow-up was 33 months; the change of estimated glomerular filtration rate was expressed as negative or positive value in mL/mo (ΔGFR). We identified two types of subgroups, on the basis of stenosis type: 1 (unilateral) N = 13 and 2 (7 bilateral, 2 single kidney, 8 prevalent kidney) N = 17; on the basis of declining ΔGFR in a pre-stenting period of 10 months: slow progressor (N = 11) and fast progressor (N = 13).

Results: Thirty-seven stents were placed successfully. After stenting the median ΔGFR value was significantly greater in subgroup 2 compared with subgroup 1 (0.02 vs. -0.16; p = 0.02). Being in fast progressor and in subgroup 2 were associated with improved renal function after stenting (8 of 13 patients, p = 0.013; 11 of 17 patients, p = 0.032). In a logistic regression the only significant relationship is between improvement of renal function and rapid decline of pre-stenting GFR (odds ratio 16; p = 0.005).

Conclusion: The predictable benefit from renal stenting may be most likely in patients presenting with a rapid decline of GFR associated with renal artery stenosis affecting the whole renal mass that is both kidneys or single functioning kidney.