Revascularization as a treatment to improve renal function

Alderson, Helen; Ritchie, James; Kalra, Philip A.

doi:10.2147/ijnrd.s35633

Cited by 3 publications

(1 citation statement)

References 82 publications

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“…Thus, clinical characteristics (underlying pathophysiology) of almost half of the patients may have played a role in the indifferent results of the trials. Furthermore, evidence obtained by subanalysis of these trials supports the notion that renal artery stenosis of at least 80% (associated or not with severe uncontrolled hypertension), patients with a rapid deterioration of renal function, and patients presenting with flash pulmonary edema distinctly benefited from PTRAS 3, 10, 11 . The selective but limited beneficial effects of PTRAS for ARVD highlight the complexity of the disease and suggest that factors prior to and beyond the vascular obstruction may likely be determinants in the outcome.…”

Section: The Bumps In the Roadmentioning

confidence: 61%

Understanding and managing atherosclerotic renovascular disease: still a work in progress

Chade

2018

F1000Res

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Atherosclerotic renovascular disease (ARVD) is an unresolved therapeutic dilemma despite extensive pre-clinical and clinical studies. The pathophysiology of the disease has been widely studied, and many factors that may be involved in progressive renal injury and cardiovascular risk associated with ARVD have been identified. However, therapies and clinical trials have focused largely on attempts to resolve renal artery stenosis without considering the potential need to treat the renal parenchyma beyond the obstruction. The results of these trials show a staggering consistence: although nearly 100% of the patients undergoing renal angioplasty show a resolution of the vascular obstruction, they do not achieve significant improvements in renal function or blood pressure control compared with those patients receiving medical treatment alone. It seems that we may need to take a step back and reconsider the pathophysiology of the disease in order to develop more effective therapeutic strategies. This mini-review discusses potential therapeutic alternatives that focus on the renal parenchyma distal to the vascular obstruction and may provide additional tools to enhance current treatment of ARVD.

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Section: The Bumps In the Roadmentioning

confidence: 61%

Understanding and managing atherosclerotic renovascular disease: still a work in progress

Chade

2018

F1000Res

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Diffusion tensor imaging in renal artery stenosis: a preliminary report

Gaudiano

Clementi

Corcioni

et al. 2020

BJR

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Objective: To investigate the diffusion properties in the kidneys affected by renal artery stenosis (RAS) using diffusion tensor imaging (DTI). Methods: In this prospective study, 35 patients with RAS and 15 patients without renal abnormalities were enrolled and examined using DTI. Cortical and medullary regions of interest (ROIs) were located to obtain the corresponding values of the apparent diffusion coefficient (ADC) and fractional anisotropy (FA). The cortical and medullary ADC and FA were compared in the kidney affected by variable degrees of stenosis (RAS 50–75% and >75%) vs controls, using the one-way ANOVA and Student’s t-test. The Spearman correlation test was used to correlate the mean ADC and FA values in the cortex and medulla with the estimate glomerular filtration rate (eGFR). Results: For the controls, the ADC value was significantly (p = 0.03) higher in the cortex than in the medulla; the FA value was significantly (p = 0.001) higher in the medulla than in the cortex. Compared with the controls, a significant reduction in the cortical ADC was present with a RAS of 50–75% and >75% (p = 0.001 and 0.041, respectively); a significant reduction in the medullary FA was verified only for RAS >75% (p = 0.023). The Spearman correlation test did not show a statistically significant correlation between the cortical and medullary ADC and FA, and the eGFR. Conclusion: The alterations of the diffusional parameters caused by RAS can be detected by DTI and could be useful in the diagnostic evaluation of these patients. Advances in knowledge: 1. Magnetic resonance DTI could provide useful information about renal involvement in RAS. 2. Magnetic resonance DTI allows non-invasive repeatable evaluation of the renal parenchyma, without contrast media.

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Ultrasonographic Assessment of Atherosclerotic Renal Artery Stenosis in Elderly Patients with Chronic Kidney Disease: An Italian Cohort Study

et al. 2022

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Although atherosclerotic renal artery stenosis (ARAS) is strictly associated with high cardiovascular risk and mortality, it often may remain unrecognized being clinically silent and frequently masked by co-morbidities especially in elderly patients with coexisting chronic kidney disease (CKD). The present observational study was conducted in elderly CKD-patients with atherosclerosis on other arterial beds. The aims were assessment of (1) ARAS prevalence; (2) best predictor(s) of ARAS, using duplex ultrasound; and (3) cardiovascular and renal outcomes at one-year follow-up. The cohort was represented by 607 consecutive in-patients. Inclusion criteria were age ≥65 years; CKD stages 2–5 not on dialysis; single or multiple atherosclerotic plaque on epiaortic vessels, abdominal aorta, aortic arch, coronary arteries, peripheral arteries that had been previously ascertained by one or more procedures. Duplex ultrasound was used to detect ARAS. Multiple regression analysis and ROS curve were performed to identify the predictors of ARAS. ARAS was found in 53 (44%) out of 120 patients who met the inclusion criteria. In univariate analysis, GFR (b = −0.021; p = 0.02); hemoglobin (b = −0.233; p = 0.02); BMI (b = 0.134; p = 0.036) and atherosclerosis of abdominal aorta and/or peripheral vessels (b = 1.025; p < 0.001) were associated with ARAS. In multivariable analysis, abdominal aorta and/or peripheral atherosclerosis was a significant (p = 0.002) predictor of ARAS. The area under the ROC curve was 0.655 (C.I. = 0.532–0.777; p = 0.019). ARAS is common in older CKD patients with extra-renal atherosclerosis, with the highest prevalence in those with aortic and peripheral atherosclerosis. ARAS may pass by unnoticed in everyday clinical practice.

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Revascularization as a treatment to improve renal function

Cited by 3 publications

References 82 publications

Understanding and managing atherosclerotic renovascular disease: still a work in progress

Understanding and managing atherosclerotic renovascular disease: still a work in progress

Diffusion tensor imaging in renal artery stenosis: a preliminary report

Ultrasonographic Assessment of Atherosclerotic Renal Artery Stenosis in Elderly Patients with Chronic Kidney Disease: An Italian Cohort Study

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