Atherosclerotic renovascular disease and renal impairment: Can we predict the effect of intervention?

Abstract

Atherosclerotic renal artery stenosis (ARAS) is associated with hypertension, ischemic nephropathy, and high cardiovascular risk. We review the data on revascularization of the renal artery by percutaneous transluminal renal angioplasty (PTRA) and pharmacological therapy. In patients with severe ARAS and poorly controlled hypertension, PTRA can improve blood pressure control. In patients with rapid renal function loss and severe ARAS, PTRA can improve short-term renal function, but there is no evidence for long-term renoprotection. Recent evidence indicates that ARAS, and incidental renal artery stenosis, considerably increases cardiovascular risk, independent of blood pressure, renal function, and prevalent risk factors. This suggests that revascularization might potentially improve overall prognosis, but no data are available currently. The high cardiovascular risk warrants aggressive pharmacological treatment to prevent progression of the generalized vascular disorder. Ongoing trials will show whether revascularization has added, long-term effects on blood pressure, renal function, and cardiovascular prognosis.

Effect of baseline glomerular filtration rate on renal function following stenting for atherosclerotic renal artery stenosis

“…normal-to-mildly impaired and stable renal function, especially patients with unilateral RAS, no improvement in renal function can be expected, and the effect of revascularization on the long-term prognosis is uncertain [25]. La Batide-Alanore et al [26] demonstrated a possible explanation for the slight change in GFR after PTRAS in patients with normal GFR.…”