Effectiveness of Management Strategies for Renal Artery Stenosis: A Systematic Review

Balk, Ethan M; Raman, Gowri; Chung, Mei; Ip, Stanley; Tatsioni, Athina; Alonso, Álvaro; Chew, Priscilla; Gilbert, Scott J.; Lau, Joseph

doi:10.7326/0003-4819-145-12-200612190-00143

Cited by 168 publications

(120 citation statements)

References 63 publications

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“…6,7 Surgical or percutaneous transluminal revacularisation are effective treatment; however, it is not clear whether it is superior to medical treatment alone. 8 Renal vein renin ratio (RVRR) can be used as a diagnostic and prognostic tool in renovascular hypertensive disease. 9 It is an invasive test done with angiographic sampling; a high renin gradient on the affected renal side coupled with a low gradient on the contralateral side is called lateralisation.…”

Section: Discussionmentioning

confidence: 99%

Role of laparoscopic nephrectomy for refractory hypertension in poorly functioning kidneys

Elhage

Sahai

Challacombe

et al. 2011

annals

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Ann R Coll Surg Engl 2011; 93: 25-26 25Hypertension affects millions around the world.1 Effective treatment is multifaceted starting with life-style changes to combination drug therapy. The main aim is to achieve a reduction in blood pressure (BP) to below 140/90 mmHg (systolic/diastolic) in order to minimise the risk of target organ damage.2 Resistant hypertension is a challenge to clinicians. The risk of organ damage increases if BP is not controlled. In selected cases of renal disease, nephrectomy may allow adequate BP control in otherwise uncontrolled hypertension. The advancement of laparoscopic nephrectomy may lead to decreased morbidity and faster recovery in these patients. Patients and MethodsAll patients referred to us had been treated for hypertension for more than 5 years. The indication for nephrectomy was uncontrolled hypertension despite long-term medical treatment, recurrent renal pain, pyelonephritis or poorly functioning kidneys. Antihypertensive medications in these patients included bendrofluazide atenolol, labetelol, indapamide, perindopril, captopril and ramipril. Pre-operatively, patients had renal ultrasound, serum creatinine, urea and full blood count assessments. Patients had functional renograms to confirm the presence of a poorly functioning kidney (< 10% of split function). They underwent laparoscopic retroperitoneal nephrectomy under general anaesthetic using a standard 3-port technique. Balloon dilatation of the retroperitoneal space was performed using a visual balloon dilating trocar (balloon inflated to 500 ml). CO 2 insufflation was commenced. The Gerota's fascia was opened and the renal vessels identified, clipped and cut. The kidney was carefully dissected free and removed through the extended middle camera port. 4A total of 12 patients (7 females, 5 males) underwent laparoscopic retroperitoneal nephrectomy between 2002 and 2006. The mean age was 41 years (range, 30-65 years). The pre-operative blood pressure was 165 ± 35 mmHg systolic and 102 ± 29 mmHg diastolic (mean ± SEM). Mean serum creatinine preoperatively was 110 µmol/l (range, 53-125 µmol/l). Pre-operatively, five patients were on two antihypertensives, six were on one antihypertensive, and one was on four antihypertensive medications. Patients were followed up for a mean of 4.2 years (range, 2-6 years). ResultsThe mean blood loss was 75 ml (range, 25-250 ml), mean operative time 112 min (range, 70-400 min) and mean hospital-stay 2.5 days (range, 2-4 days). The mean time for full recovery was 3 weeks (range, 2-6 weeks). Mean creatinine postoperatively was 113 µmol/l (range, 54-120 µmol/l). Persistent hypertension can be difficult to manage and have detrimental effect on vital organs. Nephrectomy of poorly functioning kidneys may be indicated in a minority of such cases. PATIENTS AND METHODS We performed laparoscopic nephrectomy on 12 patients with refractory hypertension. RESULTS Eight had complete response, three had partial response and one had no response. CONCLUSIONS Laparoscopic nephrectomy has a role in carefu...

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Section: Discussionmentioning

confidence: 99%

Role of laparoscopic nephrectomy for refractory hypertension in poorly functioning kidneys

Elhage

Sahai

Challacombe

et al. 2011

annals

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“…Platelet activation leading to thrombus formation is a well described complication of coronary artery disease, yet its occurrence in renal artery stenosis (RAS) is unknown (1)(2)(3)(4). RAS is a major cause of secondary hypertension and an important cause of renal failure (1)(2)(3)5,6).…”

Section: Introductionmentioning

confidence: 99%

“…RAS is a major cause of secondary hypertension and an important cause of renal failure (1)(2)(3)5,6). Although the utility of stent revascularization in patients with RAS is uncertain, several studies suggest that at least a portion of patients develop a loss of kidney function after the procedure (1)(2)(3)6,7). Soluble CD40 ligand (sCD40L) is expressed and secreted by platelets after activation and plays a vital role in the immune, inflammatory, and coagulative responses after injury or stress, and in the setting of transplantation has been linked to renal fibrosis (8 -15).…”

Section: Introductionmentioning

confidence: 99%

Platelet Activation in Patients with Atherosclerotic Renal Artery Stenosis Undergoing Stent Revascularization

Adlakha

Reed

Brewster

et al. 2011

Clinical Journal of the American Society of Nephrology

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SummaryBackground and objectives Soluble CD40 ligand (sCD40L) is a marker of platelet activation; whether platelet activation occurs in the setting of renal artery stenosis and stenting is unknown. Additionally, the effect of embolic protection devices and glycoprotein IIb/IIIa inhibitors on platelet activation during renal artery intervention is unknown.Design, setting, participants, & measurements Plasma levels of sCD40L were measured in healthy controls, patients with atherosclerosis without renal stenosis, and patients with renal artery stenosis before, immediately after, and 24 hours after renal artery stenting.Results Soluble CD40L levels were higher in renal artery stenosis patients than normal controls (347.5 Ϯ 27.0 versus 65.2 Ϯ 1.4 pg/ml, P Ͻ 0.001), but were similar to patients with atherosclerosis without renal artery stenosis. Platelet-rich emboli were captured in 26% (9 of 35) of embolic protection device patients, and in these patients sCD40L was elevated before the procedure. Embolic protection device use was associated with a nonsignificant increase in sCD40L, whereas sCD40L declined with abciximab after the procedure (324.9 Ϯ 42.5 versus 188.7 Ϯ 31.0 pg/ml, P ϭ 0.003) and at 24 hours.Conclusions Atherosclerotic renal artery stenosis is associated with platelet activation, but this appears to be related to atherosclerosis, not renal artery stenosis specifically. Embolization of platelet-rich thrombi is common in renal artery stenting and is inhibited with abciximab.

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“…The progress of both tools and technics of angioplasty have led to generalization of percutaneous renal artery repermeabilization. Despite this fact, the extensive data on consistent lots of renal hypertensive patients are missing from the literature [2,15]. The angioplasty literature reported few cases of concomitant endoluminal dilatation and stenting of multiple renal arteries [11,16].…”

Section: Introductionmentioning

confidence: 99%

Renovascular Arterial Hypertension Due to Triple Renal Arteries Stenoses: One Session Successful Stenting

Antohe¹,

Rotar²,

Minea³

2016

IOSR

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Effectiveness of Management Strategies for Renal Artery Stenosis: A Systematic Review

Cited by 168 publications

References 63 publications

Role of laparoscopic nephrectomy for refractory hypertension in poorly functioning kidneys

Role of laparoscopic nephrectomy for refractory hypertension in poorly functioning kidneys

Platelet Activation in Patients with Atherosclerotic Renal Artery Stenosis Undergoing Stent Revascularization

Renovascular Arterial Hypertension Due to Triple Renal Arteries Stenoses: One Session Successful Stenting

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