AI Article Synopsis
- Previous trials found revascularization for atherosclerotic renal artery stenosis (ARAS) ineffective; this study assessed percutaneous transluminal angioplasty with stent insertion (PTA/S) effects on kidney function and blood pressure (BP).
- Of 47 patients undergoing PTA/S, 21 were high-risk due to conditions like pulmonary edema and refractory hypertension, showing varied improvements in kidney function and significant BP control, especially in high-risk individuals.
- The results indicate PTA/S could enhance BP and kidney function in high-risk ARAS patients, emphasizing the need for individualized assessment for optimal outcomes.
Article Abstract
Background: Previous randomized controlled trials of revascularization for atherosclerotic renal artery stenosis (ARAS) were not successful. We investigated the effects of percutaneous transluminal angioplasty with stent insertion (PTA/S) on kidney function and blood pressure (BP) control in patients with ARAS.
Methods: From 2000 to 2017, 47 subjects who underwent PTA/S for ARAS were identified. A high-risk group was defined, composed of patients having one or more of the following clinical presentations: pulmonary edema, refractory hypertension, and rapid deterioration of kidney function. Subjects who met the criteria of 'kidney function improvement' or 'hypertension improvement' after PTA/S were classified as responders.
Results: Twenty-one (44.7%) subjects were classified into the high-risk group. Two subjects (8.0%) in the low-risk group (n = 25) and 5 subjects (27.8%) in the high-risk group (n = 18) showed improvement in kidney function after PTA/S ( = 0.110). In patients with rapid decline of kidney function, estimated glomerular filtration rate improved from 28 (interquartile range [IQR], 10-45) mL/min/1.73 m to 41 (IQR, 16-67) mL/min/1.73 m at 4 months after PTA/S, although the difference was not significant ( = 0.084). Regarding BP control, 9 (36.0%) and 14 (77.8%) subjects showed improvement after PTA/S in the low- (n = 25) and high-risk (n = 18) groups, respectively ( = 0.007). In patients with refractory hypertension, the systolic BP dropped from 157 (IQR, 150-164) mmHg to 140 (IQR, 131-148) mmHg at 4 months after PTA/S ( = 0.005). Twenty-five subjects were defined as responders and comprised a significant proportion of the high-risk group ( = 0.004).
Conclusion: PTA/S might improve BP control and kidney function in patients with ARAS presenting with high-risk clinical features. The optimal application of PTA/S should be based on individual assessment of the clinical significance of renal artery stenosis.
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| http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6727892 | PMC |
| http://dx.doi.org/10.23876/j.krcp.18.0148 | DOI Listing |
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