Predicting the outcome of invasive treatment of renal artery disease.
OBJECTIVE
Analysis of the factors influencing the outcome of performed or attempted invasive treatment for renal artery disease (RAD).


METHODS
University Hospital.


METHODS
Thirty-five hypertensive patients with 31 stenoses and 14 occlusions of renal artery.


METHODS
Angioplasty was performed on 25 patients (attempted for 30), primary stenting on one, nephrectomy on three, and renal resection on one patient.


METHODS
A decrease of diastolic blood pressure (DBP) by >/=15 mmHg after intervention.


RESULTS
A DBP response was seen in 24 patients. In 11 patients, invasive treatment did not result in a DBP response or failed technically. Compared with these patients, the responders were younger (55 +/- 11 vs. 66 +/- 8 years, P = 0.001) and tended to have higher DBP (100 +/- 8 vs. 93 +/- 11 mmHg, P = 0.065). The function of the affected kidney, or that of the more affected kidney if RAD was bilateral, was better preserved in responders (relative clearance on captopril renography 23 +/- 15 vs. 8 +/- 4%, P = 0.008). A response was more often seen in unilateral than in bilateral RAD (81% vs. 33%, P = 0.015). A relative clearance of </=10% on captopril renography had sensitivity of 88% and specificity of 81% for renal artery occlusion. Step-wise logistic analysis. (1) When DBP was< 95 mmHg with two antihypertensives, the response rate was 1/6 vs. 24/29 for more severe hypertension (P = 0.004). (2) Elderly patients had a response rate of 2/5 vs. 22/24 in younger patients (P = 0.024). (3) Response rates in bilateral and unilateral disease were not different, nor did the function of the affected kidney impact the DBP response. However, three of the four responders with </=10% relative clearance had an occluded renal artery and underwent nephrectomy.


CONCLUSIONS
Middle-aged patients with easily controlled hypertension and elderly hypertensives do not usually have a blood pressure response to the performed or attempted invasive treatment of RAD. Therefore, it seems recommendable not to screen such patients for RAD, unless their renal function is deteriorated. If the affected kidney functions poorly on captopril renography, angioplasty is usually not applicable and seldom leads to a blood pressure response.
Helin
K H
KH
Department of Internal Medicine, Helsinki University Hospital, Helsinki, Finland. karri.helin@huch.fi
Lepäntalo
M
M
Edgren
J
J
Liewendahl
K
K
Tikkanen
T
T
Tikkanen
I
I
D000328:Adult; D000368:Aged; D017130:Angioplasty; D000959:Antihypertensive Agents; D001794:Blood Pressure; D002216:Captopril; D003971:Diastole; D005260:Female; D006801:Humans; D006978:Hypertension, Renovascular / Q000097:blood / Q000150:complications* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy; D011237:Predictive Value of Tests; D011859:Radiography; D011866:Radioisotope Renography / Q000379:methods; D012078:Renal Artery Obstruction / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D012083:Renin / Q000097:blood; D012189:Retrospective Studies; D012307:Risk Factors; D015607:Stents; D016896:Treatment Outcome
D000959:Antihypertensive Agents; D002216:Captopril; D012083:Renin