Long-term effects of arterial stenting on kidney function for patients with ostial atherosclerotic renal artery stenosis and renal insufficiency.
It is uncertain whether renal artery stent placement in patients with atherosclerotic renovascular renal failure can prevent further deterioration of renal function. Therefore, the effects of renal artery stent placement, followed by patency surveillance, were prospectively studied in 63 patients with ostial atherosclerotic renal artery stenosis and renal dysfunction (i.e., serum creatinine concentrations of >120 micromol/L (median serum creatinine concentration, 171 micromol/L; serum creatinine concentration range, 121 to 650 micromol/L). Pre-stent renal (dys) function was stable for 28 patients and declining for 35 patients (defined as a serum creatinine concentration increase of > or =20% in 12 mo). The median follow-up period was 23 mo (interquartile range, 13 to 29 mo). Angioplasty to treat restenosis was performed in 12 cases. Five patients reached end-stage renal failure within 6 mo, and this was related to stent placement in two cases. Two other patients died or were lost to follow-up monitoring within 6 mo, with stable renal function. For the remaining 56 patients, the treatment had no effect on serum creatinine levels if function had previously been stable; if function had been declining, median serum creatinine concentrations improved in the first 1 yr [from 182 micromol/L (135 to 270 micromol/L ) to 154 micromol/L (127 to 225 micromol/L ); P < 0.05] and remained stable during further follow-up monitoring. In conclusion, stent placement, followed by patency surveillance, to treat ostial atherosclerotic renal artery stenosis can stabilize declining renal function. For patients with stable renal dysfunction, the usefulness is less clear. The possible advantages must be weighed against the risk of renal failure advancement with stent placement.
Beutler
Jaap J
JJ
Departments of Nephrology and Hypertension, University Medical Center, Utrecht, The Netherlands.
VAN Ampting
Jacobine M A
JMA
Departments of Nephrology and Hypertension, University Medical Center, Utrecht, The Netherlands.
Ven
Peter J G VAN DE
PJGV
Departments of Nephrology and Hypertension, University Medical Center, Utrecht, The Netherlands.
Koomans
Hein A
HA
Departments of Nephrology and Hypertension, University Medical Center, Utrecht, The Netherlands.
Beek
Frederik J A
FJA
Department of Radiology, University Medical Center, Utrecht, The Netherlands.
Woittiez
Arend-Jan J
AJ
Department of Internal Medicine, Twenteborg Hospital, Almelo, The Netherlands.
Mali
Willem P T M
WPTM
Department of Radiology, University Medical Center, Utrecht, The Netherlands.
D000368:Aged; D000369:Aged, 80 and over; D001161:Arteriosclerosis / Q000503:physiopathology*; D001794:Blood Pressure; D005260:Female; D006801:Humans; D007668:Kidney / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012077:Renal Artery / Q000503:physiopathology*; D012078:Renal Artery Obstruction / Q000150:complications / Q000503:physiopathology* / Q000628:therapy*; D051437:Renal Insufficiency / Q000209:etiology / Q000503:physiopathology*; D015607:Stents; D016019:Survival Analysis; D013997:Time Factors; D014654:Vascular Patency