[Ischemic renal disease: revascularization or conservative treatment?].
Ischemic nephropathy is recognized as a distinct cause of renal insufficiency and it is defined as a significant reduction in glomerular filtration rate in patients with hemodynamically significant renovascular occlusive disease. We argue the epidemiologic and clinical manifestations of atherosclerotic renovascular disease, and we evaluate the pronostic agents. Published studies of the outcome of revascularization for renal-artery stenosis have been excellent, offering a durable patency and functional improvement but they have had numerous limitations. The atherosclerosis is a systemic disease and it provides the general prognosis of patients. We conclude that ischemic renal disease is a nephropathy of smoker men, with proteinuria excretion similar to nephropathy with unilateral stenosis. The age of patients is the clinical feature that decide the treatment: surgery, angioplasty/stent or medical management. Comparative analysis of percutaneous transluminal angioplasty and operation for renal revascularization and medically treated patients have proved that the advanced chronic renal insufficiency is associated with an unfavourable response of treatment of the ischemic nephropathy. But, in this nephropathy the revascularization can be the better therapy for selected patients. The revascularization with angioplasty/stent for patients with unilateral renal stenosis and chronic renal insufficiency has a doubtful effectiveness, as the chronic renal failure is result of nephroangiosclerosis.
Rodríguez Jornet
A
A
Servicios de Nefrología, Corporación Parc Taulí, Sabadell. arodriguez@cspt.es
Ibeas
J
J
Ribera
L
L
Real
J
J
Perendreu
J
J
Falcó
J
J
Vallespín
J
J
Allegué
N
N
Giménez Gaibar
A
A
García García
M
M
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000800:Angioplasty, Balloon; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001161:Arteriosclerosis / Q000150:complications / Q000601:surgery / Q000628:therapy*; D002318:Cardiovascular Diseases / Q000150:complications / Q000453:epidemiology; D002985:Clinical Protocols; D003131:Combined Modality Therapy; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology; D007511:Ischemia / Q000209:etiology / Q000601:surgery / Q000628:therapy*; D007668:Kidney / Q000098:blood supply*; D007676:Kidney Failure, Chronic / Q000209:etiology / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D009400:Nephrosclerosis / Q000150:complications; D011507:Proteinuria / Q000209:etiology; D012078:Renal Artery Obstruction / Q000150:complications / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D006435:Renal Dialysis / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012307:Risk Factors; D015607:Stents; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures
D000959:Antihypertensive Agents