Rapid decline in renal function reflects reversibility and predicts the outcome after angioplasty in renal artery stenosis

Muray, S; Martín, Marisa; Amoedo, Maria Luisa; García, Carmen; Jornet, Angel Rodríguez; Vera, María; Oliveras, Anna; Gómez, Xavier; Craver, Lourdes; Real, María Isabel; Monje-Garcia, Laura; Botey, A; Montanyà, Xavier; Fernàndez, Elvira

doi:10.1053/ajkd.2002.29881

Cited by 139 publications

(74 citation statements)

References 25 publications

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“…The level of preintervention GFR tends to predict the likely recovery potential after revascularization, as those with serum creatinine Ͼ3.0 mg/dl less commonly improve (35,36). Clinical observations confirm that the rate of loss of GFR just before renal revascularization correlates with the potential for recovery of renal function in the year after endovascular stent placement (37). Studies of diastolic blood flow, such as the Doppler ultrasound renal resistive index, demonstrate that high parenchymal resistance (Ͼ80) predicts poor renal functional recovery after successful revascularization (38).…”

Section: Pathophysiology Of "Critical" Ras and "Ischemic Nephropathy"mentioning

confidence: 86%

Ischemic Nephropathy

Textor

2004

Journal of the American Society of Nephrology

148

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Abstract. Identification and reversing the loss of kidney function beyond occlusive disease of the renal arteries poses a major clinical challenge. Recent studies indicate that atherosclerotic renal artery stenosis develops as a function of age and is commonly associated with other microvascular disease, including nephrosclerosis and diabetic nephropathy. The risks of renal artery stenosis are related both to declining kidney function and to accelerated cardiovascular disease, with increased morbidity and mortality. Newer drugs, including agents that block the renin-angiotensin system, have improved the level of BP control for renovascular hypertension. Progressive renovascular disease during medical therapy can produce refractory hypertension, congestive heart failure, and renal failure with tubulointerstitial fibrosis. Recent studies indicate a complex interplay of oxidative stress, endothelial dysfunction, and activation of fibrogenic cytokines as a result of experimental atherosclerosis and renal hypoperfusion. Advances in imaging and interventional devices offer major new opportunities to prevent progressive loss of kidney function. Recent series indicate that although 25 to 30% of patients with impaired renal function can recover glomerular filtration after revascularization, many have no apparent change in kidney function and 19 to 25% experience a significant loss of kidney function, in some cases as a result of atheroemboli. To select patients who are most likely to benefit from vascular intervention, clinicians should understand the pathophysiology of developing ischemic nephropathy and the potential hazards of revascularization in the setting of diffuse atherosclerotic disease. Further research should be directed toward identification of critical disease, regulation of fibrogenesis, and the interaction with other atherosclerotic processes.

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Section: Pathophysiology Of "Critical" Ras and "Ischemic Nephropathy"mentioning

confidence: 86%

Ischemic Nephropathy

Textor

2004

Journal of the American Society of Nephrology

148

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“…[27][28][29][30][31] For patients with a normal or mildly impaired renal function, however, it is unclear if and when intervention should be performed to prevent progressive renal failure, because the rate of progressive narrowing of the renal artery and the associated rate of progressive renal failure is generally slow. 32 Our study shows that intervention should not be postponed in patients with bilateral stenosis, even if their renal function is not impaired as yet.…”

Section: Discussionmentioning

confidence: 99%

Which patients with hypertension and atherosclerotic renal artery stenosis benefit from immediate intervention?

et al. 2004

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“…These three methods have been used to infer changes in renal function over time (5)(6)(7)(8)(9)(10). Reciprocal serum creatinine (1/SCr) has also been used to infer changes in renal function over time (7,11,12). Measured GFR with an exogenous marker such as inulin or iothalamate is the gold standard method, but expense and inconvenience are important drawbacks.…”

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confidence: 99%

Comparison of Methods for Determining Renal Function Decline in Early Autosomal Dominant Polycystic Kidney Disease

Rule¹,

Torres²,

Chapman³

et al. 2006

Journal of the American Society of Nephrology

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A decline in renal function suggests progression of chronic kidney disease. This can be determined by measured GFR (e.g., iothalamate clearance), serum creatinine (SCr)-based GFR estimates, or creatinine clearance. A cohort of 234 patients with autosomal dominant polycystic kidney disease and baseline creatinine clearance >70 ml/min were followed annually for four visits. Iothalamate clearance, SCr, and creatinine clearance were obtained at each visit. Estimated GFR (

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Rapid decline in renal function reflects reversibility and predicts the outcome after angioplasty in renal artery stenosis

Cited by 139 publications

References 25 publications

Ischemic Nephropathy

Ischemic Nephropathy

Which patients with hypertension and atherosclerotic renal artery stenosis benefit from immediate intervention?

Comparison of Methods for Determining Renal Function Decline in Early Autosomal Dominant Polycystic Kidney Disease

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