In-stent restenosis of the renal artery in a single kidney patient: the role of ACEI in the therapeutic choice.
Renal artery stenosis (RAS) caused by atherosclerotic changes of the renal arteries has become a concern as a cause of end-stage renal failure. Percutaneous balloon angioplasty with or without endovascular stenting is an increasingly accepted procedure at the expense of classical approaches such as aortorenal bypass and other types of surgery. Renal percutaneous transluminal angioplasty and stenting (RPTAS) represent the first therapeutic choice; however, there is doubt regarding the satisfactory long-term outcome for primary RPTAS. Currently, there is no clear evidence whether or not RPTAS prevents further progressive renal function decline because comparisons between interventional randomized studies and medical therapy are still lacking. Despite the fact that the use of angiotensin-converting enzyme inhibitors (ACEIs) may be a potential cause of acute renal failure, clinical data suggest that ACEI therapy is associated with better survival in patient with RAS. In our case, the use of ACEIs has been fundamental for the indirect evaluation of restenosis degree and RPTAS.
Cianci
Rosario
R
Department of Nephrology, University of Rome La Sapienza, Rome, Italy. ciancirosario@tin.it
Gigante
Antonietta
A
Polidori
Lelio
L
Di Donato
Domenico
D
Martina
Paola
P
Barbano
Biagio
B
Renzulli
Roberta
R
Zaccaria
Alvaro
A
Fuiano
Giorgio
G
D058186:Acute Kidney Injury / Q000209:etiology; D000368:Aged; D000800:Angioplasty, Balloon / Q000295:instrumentation*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D000959:Antihypertensive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects*; D018450:Disease Progression; D006801:Humans; D006978:Hypertension, Renovascular / Q000175:diagnosis / Q000188:drug therapy / Q000503:physiopathology / Q000628:therapy*; D007674:Kidney Diseases / Q000150:complications* / Q000503:physiopathology; D008297:Male; D018579:Patient Selection; D012008:Recurrence; D012078:Renal Artery Obstruction / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy / Q000628:therapy*; D018570:Risk Assessment; D012720:Severity of Illness Index; D015607:Stents; D016896:Treatment Outcome
D000806:Angiotensin-Converting Enzyme Inhibitors; D000959:Antihypertensive Agents