Prospective evaluation of aggressive medical therapy for atherosclerotic renal artery stenosis, with renal artery stenting reserved for previously injured heart, brain, or kidney.
Sixty-six patients with atherosclerotic renal artery stenosis (RAS) and serum creatinine < or =2.0 mg/dl were treated with antihypertensive therapy, a statin, and aspirin. Renal stenting was reserved for patients with injuries to the heart, brain, or kidneys. The primary end point was stenotic kidney glomerular filtration rate (GFR) at 21 months; secondary end points included major adverse clinical events, serum creatinine, total GFR, and blood pressure (BP). After baseline evaluation, 26 of 66 patients underwent renal stenting because of injuries to the heart, brain, or kidneys. After 21 months, 6 medical patients required renal stenting, and 5 patients experienced late clinical events (2 medical patients, 3 stent patients). There was no difference in final BP between groups. Whereas medical patients experienced 6% and 8% decreases in total and stenotic kidney GFR, stent patients experienced 7% and 11% increases in total kidney (p = 0.006) and stenotic kidney (p = 0.02) GFR. There was no difference in final serum creatinine. In conclusion, patients with atherosclerotic RAS and baseline creatinine < or =2.0 mg/dl can be safely managed with aggressive medical therapy, with a small decrease in GFR. For patients who develop injuries to the heart, brain, or kidneys, renal artery stenting may further reduce hypertension and improve renal function.
Hanzel
George
G
Division of Cardiology, William Beaumont Hospital, Royal Oak, Michigan.
Balon
Helena
H
Wong
Oliver
O
Soffer
Daniel
D
Lee
Daniel Taehee
DT
Safian
Robert David
RD
D000368:Aged; D000792:Angiography; D050197:Atherosclerosis / Q000150:complications* / Q000503:physiopathology / Q000601:surgery; D001794:Blood Pressure / Q000502:physiology; D019917:Blood Vessel Prosthesis Implantation / Q000295:instrumentation*; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate / Q000502:physiology; D006333:Heart Failure / Q000150:complications* / Q000503:physiopathology; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000503:physiopathology; D011379:Prognosis; D011446:Prospective Studies; D012077:Renal Artery / Q000000981:diagnostic imaging / Q000601:surgery; D012078:Renal Artery Obstruction / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D015607:Stents; D020521:Stroke / Q000150:complications* / Q000503:physiopathology; D016896:Treatment Outcome