title: Effect of renal-artery stenting on progression of renovascular renal failure.
abstract: BACKGROUND
  Placement of renal-artery stents has a high technical success rate in atherosclerotic renovascular disease, but little is known about the clinical benefits of the procedure. We monitored renal function serially before and after stent insertion in patients with renovascular renal failure.
  
  
  METHODS
  Renal function was assessed before and after stent placement by means of serial serum creatinine values in 32 patients with atherosclerotic renal-artery stenosis. The effect on the progression of renal failure was analysed in 23 patients by comparison of the reciprocal slopes of serum creatinine versus time plots before and after stent placement.
  
  
  RESULTS
  33 transluminal stents were placed in 32 patients with atherosclerotic renovascular disease. Immediate patency was achieved in all cases: the angiographic restenosis rate at 6 months was 12% (n = 24). One patient died after a procedure-related haemorrhage. Median diastolic blood pressure was significantly lower after stenting than before (95 [IQR 86-103] vs 87 [81-90] mm Hg; p > 0.01) but the requirement for antihypertensive drugs was unchanged. Renal function improved or stabilised in 22 (69%) of the 32 patients. Progression of renal failure was significantly slowed after the procedure; the mean (SE) of the slopes of reciprocal serum creatinine values was -4.34 (0.85) L mumol-1 day-1 before stent placement, and -0.55 (1.0) L mumol-1 day-1 after stent placement (p < 0.01, two-sample t test).
  
  
  CONCLUSIONS
  Renal-stent placement in selected patients slows the progression of renovascular renal failure and may delay the need for renal replacement therapy.
authors.affiliation: Renal Unit, Western Infirmary, Glasgow, UK.
authors.forename: P N
authors.initials: PN
authors.lastname: Harden
authors.forename: M J
authors.initials: MJ
authors.lastname: MacLeod
authors.forename: R S
authors.initials: RS
authors.lastname: Rodger
authors.forename: G M
authors.initials: GM
authors.lastname: Baxter
authors.forename: J M
authors.initials: JM
authors.lastname: Connell
authors.forename: A F
authors.initials: AF
authors.lastname: Dominiczak
authors.forename: B J
authors.initials: BJ
authors.lastname: Junor
authors.forename: J D
authors.initials: JD
authors.lastname: Briggs
authors.forename: J G
authors.initials: JG
authors.lastname: Moss
mesh_terms: D000368:Aged; D001161:Arteriosclerosis / Q000628:therapy*; D001794:Blood Pressure; D003404:Creatinine / Q000097:blood; D006801:Humans; D006978:Hypertension, Renovascular / Q000628:therapy; D007676:Kidney Failure, Chronic / Q000628:therapy; D008875:Middle Aged; D012077:Renal Artery; D012078:Renal Artery Obstruction / Q000401:mortality / Q000628:therapy*; D015607:Stents; D016896:Treatment Outcome; D014654:Vascular Patency
chemical_list: D003404:Creatinine