[Management of atherosclerotic renal artery stenoses].
Patients with atherosclerotic renal artery stenosis may develop hypertension, recurrent pulmonary edema and chronic renal failure, but have a much higher risk of dying from stroke or myocardial infarction than of progressing to end-stage renal disease. Indeed, atherosclerotic renal artery stenosis typically occurs in high risk patients with coexistent vascular disease elsewhere. Recent controlled trials comparing medication to revascularization have shown that only a minority of such patients can expect hypertension cure, whereas the results of trials designed to document the ability of revascularization to prevent progressive renal failure are not yet available. Revascularization should be undertaken in patients with atherosclerotic renal artery stenosis and resistant hypertension or heart failure, and probably in those with rapidly deteriorating renal function or with an increase in plasma creatinine levels during angiotensin-converting enzyme inhibition, especially if their renal resistance--index before revascularization is less than 80. With or without revascularization, medical therapy using antihypertensive agents, statins and aspirin is necessary in almost all cases.
Rossignol
P
P
Service d'Hypertension Artérielle, Hôpital Européen Georges Pompidou, 20 rue Leblanc, 75908 Paris, France.
La Batida Alanore
A
A
Roueff
S
S
Bobrie
G
G
Plouin
P F
PF
D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D001161:Arteriosclerosis / Q000150:complications / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000453:epidemiology / Q000601:surgery*; D001241:Aspirin / Q000627:therapeutic use; D002317:Cardiovascular Agents / Q000627:therapeutic use; D003131:Combined Modality Therapy; D003404:Creatinine / Q000097:blood; D003952:Diagnostic Imaging; D004359:Drug Therapy, Combination; D006333:Heart Failure / Q000188:drug therapy / Q000209:etiology; D006801:Humans; D006978:Hypertension, Renovascular / Q000188:drug therapy / Q000209:etiology; D000960:Hypolipidemic Agents / Q000627:therapeutic use; D009203:Myocardial Infarction / Q000209:etiology / Q000517:prevention & control; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D011654:Pulmonary Edema / Q000209:etiology; D011877:Radionuclide Imaging; D012077:Renal Artery / Q000000981:diagnostic imaging / Q000601:surgery; D012078:Renal Artery Obstruction / Q000150:complications / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000453:epidemiology / Q000601:surgery*; D012307:Risk Factors; D020521:Stroke / Q000209:etiology / Q000517:prevention & control
D000806:Angiotensin-Converting Enzyme Inhibitors; D002317:Cardiovascular Agents; D000960:Hypolipidemic Agents; D010975:Platelet Aggregation Inhibitors; D003404:Creatinine; D001241:Aspirin
Prise en charge des sténoses athéroscléreuses des artères rénales.