Evaluation and approach to treatment of renal artery stenosis in patients with diabetic nephropathy.
Patients with diabetes mellitus are at increased risk for developing peripheral vascular disease and renal artery stenosis (RAS). Furthermore, in diabetic patients the progression of renal atherosclerotic disease toward critical stenosis or occlusion occurs more frequently than in their nondiabetic counterparts. Consequently, clinicians must carry a high level of suspicion for detecting RAS in diabetic patients, particularly those with established coronary and/or peripheral atherosclerotic disease and compromised renal function. In this group of patients early detection of this condition, preferably with a noninvasive diagnostic test, is very important to plan revascularization therapy. In nondiabetic patients, several studies have demonstrated that catheter-based revascularization therapy may arrest or revert renal dysfunction in patients with RAS. Although still the subject of debate, a recent study has shown that in diabetic patients with RAS and impaired renal function, revascularization therapy with endovascular stents has a positive impact in the progression of renal dysfunction.
Silva
Jose A
JA
Tchefuncte Cardiovascular Associates and TCA Research, 101 East Fairway Drive, Suite 504, Covington, LA 70433, USA. drsilva@tcaway.com
D003928:Diabetic Nephropathies / Q000150:complications* / Q000503:physiopathology; D018450:Disease Progression; D006801:Humans; D009204:Myocardial Revascularization / Q000379:methods*; D016491:Peripheral Vascular Diseases / Q000209:etiology / Q000473:pathology; D012078:Renal Artery Obstruction / Q000209:etiology / Q000473:pathology / Q000601:surgery*; D012307:Risk Factors; D016896:Treatment Outcome