Functional effects of renal artery stent placement on treated and contralateral kidneys

Leertouwer, Trude C.; Derkx, F. H. M.; Pattynama, Peter M. T.; Deinum, Jaap; Dijk, Lukas C. van; Schalekamp, M. A. D. H.

doi:10.1046/j.1523-1755.2002.00456.x

Cited by 39 publications

(26 citation statements)

References 9 publications

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“…In unilateral renal artery stenosis, the unobstructed kidney is capable of compensating for the contralateral stenotic kidney by increasing its GFR. 24,25 After revascularization, however, the compensatory increase in GFR of the nonobstructed kidney returns to baseline, and the overall GFR remains unaltered. Although BNP has been reported to be elevated in patients with a GFR Ͻ60 mL · min Ϫ1 · 1.73 m Ϫ2 , 26 our data demonstrated no statistical significant difference for elevated BNP (Ͼ80 pg/mL) stratified for an eGFR Ͻ60 or Ͼ60 mL · min Ϫ1 · 1.73 m Ϫ2 (92% versus 67%; Pϭ0.14).…”

Section: Discussionmentioning

confidence: 99%

Elevated Brain Natriuretic Peptide Predicts Blood Pressure Response After Stent Revascularization in Patients With Renal Artery Stenosis

et al. 2005

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Background-A significant number (20% to 40%) of hypertensive patients with renal artery stenosis will not have blood pressure improvement after successful percutaneous revascularization. Identifying a group of patients with refractory hypertension and renal artery stenosis who are likely to respond to renal stent placement would be beneficial. Methods and Results-Brain natriuretic peptide (BNP) was measured in 27 patients with refractory hypertension and significant renal artery stenosis before and after successful renal artery stent placement. This neuropeptide was elevated (median, 187 pg/mL; 25th to 75th percentiles, 89 to 306 pg/mL) before stent placement and fell within 24 hours of the successful stent procedure (96 pg/mL; 25th to 75th percentiles, 61 to 182 pg/mL; Pϭ0.002), remaining low (85 pg/mL; 25th to 75th percentiles, 43 to 171 pg/mL) at follow-up. Clinical improvement in hypertension was observed in the patients with a baseline BNP Ͼ80 pg/mL (nϭ22) in 17 patients (77%) compared with 0% of the patients with a baseline BNP Յ80 pg/mL (nϭ5) (Pϭ0.001). After correction for glomerular filtration rate, BNP was strongly correlated with improvement in hypertension. Conclusions-BNP is increased in patients with severe renal artery stenosis and decreases after successful stent revascularization. In addition, an elevated baseline BNP level of Ͼ80 pg/mL appears to be a good predictor of a blood pressure response after successful stent revascularization. (Circulation. 2005;111:328-333.)

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Section: Discussionmentioning

confidence: 99%

Elevated Brain Natriuretic Peptide Predicts Blood Pressure Response After Stent Revascularization in Patients With Renal Artery Stenosis

et al. 2005

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“…Several trials have documented that renal artery stent placement improves or stabilizes renal function in patients with atherosclerotic RAS (749)(750)(751)(752). Significant improvement in renal function up to 1 year after unilateral renal artery stent placement was demonstrated by Leertouwer and coworkers (701). They demonstrated that the glomerular filtration rate in the revascularized kidney improved significantly but that overall glomerular filtration rate from both kidneys did not change (721).…”

Section: Class Iib Percutaneous Revascularization May Be Considered Fmentioning

confidence: 96%

“…Revascularization is effective in stabilizing or improving renal function in patients with symptomatic atherosclerotic RAS (701,(744)(745)(746)(747)(748). Several trials have documented that renal artery stent placement improves or stabilizes renal function in patients with atherosclerotic RAS (749)(750)(751)(752).…”

Section: Class Iib Percutaneous Revascularization May Be Considered Fmentioning

confidence: 99%

ACC/AHA 2005 Practice Guidelines for the Management of Patients With Peripheral Arterial Disease (Lower Extremity, Renal, Mesenteric, and Abdominal Aortic)

Hirsch

Haskal²,

Hertzer³

et al. 2006

Circulation

2,969

1,111

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“…All presented significant atherosclerotic mmHg in the lesion). Patients were referred to renal artery angioplasty with placement of a stent according to the clinical history and physical examination analyzed in conjunction with stenosis of renal artery suggested by the renal US-Doppler and with the results of renal arteriography, similarly to procedures recommended and performed in other previous studies [14][15][16][17] .…”

Section: Discussionmentioning

confidence: 99%

“…Despite the small number of patients involved in this study, the sample tried to select the cases with a clear clinical indication for percutaneous renal revascularization, either to control systemic hypertension or to preserve or restore renal function 3,12,20,21 . In fact, several studies have evaluated the renal function after renal angioplasty with stent placement 10,11,[16][17][18][20][21][22][23] . A study carried out by Jensen 24 evaluated 107 patients with ARAS in a one-year follow-up after stenting in renal artery and found that this group showed decreased BP and increased glomerular filtration rate.…”

Section: Discussionmentioning

confidence: 99%

Eficácia clínica da revascularização renal percutânea com implante de stent em pacientes com doença renovascular aterosclerótica

Gonçalves¹,

Amorim²,

Neto³

et al. 2007

Arq. Bras. Cardiol.

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Objective: To evaluate the clinical efficacy of percutaneous renal revascularization with stenting to control hypertension and preserve/restore renal function in patients with atherosclerotic renovascular disease. Methods:From May/1999 to October/2003, 46 patients with atherosclerotic renal artery stenosis (ARAS) underwent revascularization with stenting. The indication for the procedure was hypertension control and/or renal function preservation/ restoration. Clinical characteristics: age range: 33-84 years (median = 58.5 ±10.7), males: 26 (56.5%), 4 (10%) patients with dia betes mellitus, 21 (46%) patients with coronary artery disease, creatinine <2.0mg/dl: 39 (64%), 6 patients (14%) with congestive heart failure, 20 (43%) patients with ostial stenosis and 15 (33%) patients with bilateral stenosis. Hypertension control was evaluated by the number of drugs used before the procedure and at follow-up (FU) and by blood pressure (BP) measurement. Results:The minimum follow-up was 7 months (range of 7-52, median: 23, mean: 24.2 ± 15.2). There were no major complications. No patient experience any cardiovascular event. There was only one non-cadiac death (2%) and one technical failure in the treatment(2%). There was no serious complication in the procedure. None of the patients presented cardiovascular events. The renal function improved or stabilized in 32 patients (82%) and worsened in 4 (10%). The BP control improved in 19/44 (43,8%) patients and worsened / stabilized in 6 patients (14%). Conclusion:Angioplasty with renal artery stenting for ARAS showed to be an effective treatment strategy to restore and preserve renal function and to control blood pressure. Atherosclerotic renal artery stenosis (ARAS) is one of the causes of systemic hypertension (SH) and renal failure 1-3 . Its real prevalence is unknown, but it is estimated that up to 5% of hypertensive patients have ARAS as the etiology of SH. The clinical relevance of ARAS has increased due to global longer life expectancy and higher prevalence of SH and diabetes mellitus 4,5 . In this group of patients, the simultaneous occurrence of atherosclerosis in different sites is very common 6 . A study carried out by Baboolal, in 1998, described the mortality, the rate of renal function decrease and the incidence of end-stage renal disease in 51 patients with bilateral ARAS, who were followed up during a mean of 52 months 7 . Such patients did not undergo percutaneous or surgical intervention. The evaluation of renal function showed impairment at the time of angiography and a variable, non-uniform decline during the observation period. After 5 years, there was a progressive increase in the incidence of end-stage renal disease (ESRD). Six out of 51 patients who were evaluated with angiography presented ESRD. The therapeutic resources for ARAS are the control of SH and other risk factors for cardiovascular events and renal revascularization, which can be achieved by surgery or angioplasty (with or without stent placement).Percutaneous revascularization techniques are...

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Functional effects of renal artery stent placement on treated and contralateral kidneys

Abstract: Renal artery stenting was capable of causing improvement of glomerular filtration rate of the treated kidney, although the overall glomerular filtration rate did not change.

Cited by 39 publications

References 9 publications

Elevated Brain Natriuretic Peptide Predicts Blood Pressure Response After Stent Revascularization in Patients With Renal Artery Stenosis

Elevated Brain Natriuretic Peptide Predicts Blood Pressure Response After Stent Revascularization in Patients With Renal Artery Stenosis

ACC/AHA 2005 Practice Guidelines for the Management of Patients With Peripheral Arterial Disease (Lower Extremity, Renal, Mesenteric, and Abdominal Aortic)

Eficácia clínica da revascularização renal percutânea com implante de stent em pacientes com doença renovascular aterosclerótica

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