Early Rapid Decline in Kidney Function in Medically Managed Patients With Atherosclerotic Renal Artery Stenosis

Abstract

Background Early rapid declines of kidney function may occur in patients with atherosclerotic renal artery stenosis with institution of medical therapy. The causes and consequences are not well understood. Methods and Results Patients enrolled in the medical therapy–only arm of the CORAL (Cardiovascular Outcomes With Renal Artery Lesions) study were assessed for a rapid decline ( RD ) in estimated glomerular filtration rate ( eGFR ), defined as a ≥30% decrease from baseline to either 3 months, 6 months, or both. In the medical therapy–only cohort, eGFR was available in 359 subjects at all time points, the subjects were followed for a median of 4.72 years, and 66 of 359 (18%) subjects experienced an early RD . Baseline log cystatin C (odds ratio, 1.78 [1.11–2.85]; P =0.02), age (odds ratio, 1.04 [1.00–1.07]; P <0.05), and Chronic Kidney Disease Epidemiology Collaboration creatinine eGFR (odds ratio, 1.86 [1.15–3.0]; P =0.01) were associated with an early RD . Despite continued medical therapy only, the RD group had an improvement in eGFR at 1 year (6.9%; P =0.04). The RD and nondecline groups were not significantly different for clinical events and all‐cause mortality ( P =0.78 and P =0.76, respectively). Similarly, renal replacement therapy occurred in 1 of 66 (1.5%) of the RD patients and in 6 of 294 (2%) of the nondecline patients. The regression to the mean of improvement in eGFR at 1 year in the RD group was estimated at 5.8±7.1%. Conclusions Early rapid declines in kidney function may occur in patients with renal artery stenosis when medical therapy is initiated, and their clinical outcomes are comparable to those without such a decline, when medical therapy only is continued.

Renovascular Compression by the Diaphragmatic Crus: A Case Report

“…Although ARB decreases the glomerular filtration rate (GFR) initially, it does not cause a long-term loss in renal function. In addition to that, ARB is a reno-protective drug [ 14 , 15 ]. A combination of ACE/ARB with calcium channel blockers and diuretics can attain the goal of blood pressure [ 15 ].…”

Stem Cell Therapy for Microvascular Injury Associated with Ischemic Nephropathy

“…These observations were confirmed and extended with transjugular biopsies of post-stenotic kidneys demonstrating remarkably intact tubular and glomerular structures, although glomerular volume measurements confirm reduced perfusion [ 32 ]. These investigational data provide a physiologic basis for the observation that many patients with moderate ARVD can be managed for many years with stable CKD without progressive injury [ 8 , 33 ].…”

Hipertensión renovascular: actualización

“…En algunos pacientes, este aumento de la creatininemia pueda atenuarse al suspender el tratamiento diurético. El deterioro de la filtración glomerular con el inicio del tratamiento médico, si no es grave, no modifica el pronóstico del paciente a largo plazo 43 .…”