title: Rapid decline in renal function reflects reversibility and predicts the outcome after angioplasty in renal artery stenosis.
abstract: Percutaneous transluminal renal angioplasty (PTRA) has a beneficial effect on renal function in some, but not all, patients with atheromatous renal artery stenosis. Our aim is to identify factors influencing clinical success after PTRA in this group of patients. Seventy-three patients undergoing PTRA were studied; 14 patients were excluded from final analysis because of restenosis. All patients had chronic renal failure secondary to vascular nephropathy and renal artery stenosis. The diagnosis of renal artery stenosis was based on carbon dioxide digital angiography showing greater than 60% luminal narrowing. The rate of renal failure progression was assessed by the slope of the regression line of serum creatinine versus time. At least three consecutive creatinine measurements before and after angioplasty were required for study entry. Response to PTRA was made by comparison of the slope before and after PTRA. The association of age, serum creatinine level, proteinuria, renal size, pre-PTRA slope value, diabetes, ischemic heart disease, peripheral vascular disease, and cerebrovascular disease with response to PTRA was assessed by multiple regression analysis, with changes in slope values as the dependent variable. Renal function improved in 34 of 59 patients (57.6%). Mean follow-up was 627 +/- 284 (SD) days. The slope of the reciprocal serum creatinine plot before PTRA was significantly associated with a favorable change in progression rate after PTRA (beta = -0.012; P = 0.004). A scatter plot showed a statistically significant inverse correlation between pre-PTRA slope values and post-PTRA slope changes (r = -0.46; P = 0.000). Rapidly progressive renal failure is associated with a favorable response on renal failure progression after PTRA in patients with vascular nephropathy and renal artery stenosis.
authors.affiliation: Service of Nephrology and Department of Internal Medicine, Hospital Universitari Arnau de Vilanova, Lleida, Spain.
authors.forename: Salomé
authors.initials: S
authors.lastname: Muray
authors.forename: Marisa
authors.initials: M
authors.lastname: Martín
authors.forename: Maria Luisa
authors.initials: ML
authors.lastname: Amoedo
authors.forename: Carme
authors.initials: C
authors.lastname: García
authors.forename: Angel Rodriguez
authors.initials: AR
authors.lastname: Jornet
authors.forename: Manuel
authors.initials: M
authors.lastname: Vera
authors.forename: Anna
authors.initials: A
authors.lastname: Oliveras
authors.forename: Xavier
authors.initials: X
authors.lastname: Gómez
authors.forename: Lourdes
authors.initials: L
authors.lastname: Craver
authors.forename: Maria Isabel
authors.initials: MI
authors.lastname: Real
authors.forename: Laura
authors.initials: L
authors.lastname: García
authors.forename: Albert
authors.initials: A
authors.lastname: Botey
authors.forename: Xavier
authors.initials: X
authors.lastname: Montanyà
authors.forename: Elvira
authors.initials: E
authors.lastname: Fernández
mesh_terms: D000368:Aged; D000800:Angioplasty, Balloon / Q000379:methods*; D003404:Creatinine / Q000097:blood; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007668:Kidney / Q000473:pathology / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D012078:Renal Artery Obstruction / Q000097:blood / Q000503:physiopathology / Q000628:therapy*; D016896:Treatment Outcome
chemical_list: D003404:Creatinine