Comparison of early and long-term impact of percutaneous transluminal renal artery angioplasty alone or with brachytherapy on renal function in patients with reno-vascular hypertension.
BACKGROUND
Renal ischaemia resulting from stenosis of the renal artery may result in two important sequelae: systemic arterial hypertension, and renal atrophy and nephron loss, resulting in an increased risk of progression to end-stage renal disease. Renal artery stenosis (RAS) may lead to both renovascular hypertension and ischaemic nephropathy - a potentially curable cause of renal failure.


OBJECTIVE
To assess the efficacy of g-intraluminal brachytherapy (ILBT) in prevention of restenosis after percutaneous transluminal renal artery angioplasty (PTRA) and the effects of this method of revascularisation on renal function.


METHODS
71 patients aged 52+/-8 years with refractory renovascular hypertension were randomised to group I (PTRA + ILBT) or group II (PTRA). Both baseline and 9-month follow-up angiography, intra-vascular ultrasound and non-invasive examination were performed to assess the efficacy of PTRA on renal function.


RESULTS
The overall PTRA success rate was 87%: 33 patients from group I and 29 from group II underwent a successful procedure. A decrease of serum creatinine level was observed regardless of the treatment modality, directly after angioplasty: 20 micromol/l (17.5%) in group I and 26 micromol/l (22%) in group II (NS). Also in long-term follow-up this effect was sustained: 18 micromol/l (15.8%) in group I and 10 micromol/l (8.5%) in group II (NS). In the follow-up period a non-significant increase of serum creatinine level was observed in group I (from 94+/-19 to 96+/-25 micromol/l, NS). In group II the increase of serum creatinine level was significantly higher (from 92+/-39 micromol/l to 108+/-60 micromol/l, p=0.001).


CONCLUSIONS
PTRA improves renal function in patients with ischaemic nephropathy. In long-term observation the positive effect of PTRA on renal function is especially visible in patients with ILBT after PTRA.
Lekston
Andrzej
A
Silesian Centre for Heart Diseases, Zabrze, Poland.
Chudek
Jerzy
J
Gasior
Mariusz
M
Wilczek
Krzysztof
K
Wiecek
Andrzej
A
Kokot
Franciszek
F
Szyguła-Jurkiewicz
Bozena
B
Wojnicz
Romuald
R
Osuch
Marcin
M
Poloński
Lech
L
D000368:Aged; D000800:Angioplasty, Balloon / Q000379:methods*; D001918:Brachytherapy / Q000379:methods*; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D006978:Hypertension, Renovascular / Q000209:etiology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D012078:Renal Artery Obstruction / Q000150:complications / Q000628:therapy*; D016896:Treatment Outcome