Predictive factors and therapeutic approach of renovascular disease: four years' follow-up.
BACKGROUND
There is no consensus about the renal function outcome after revascularization with stenting in atherosclerotic renovascular disease. In the present study, the outcome in BP control and renal function in patients with renovascular disease treated with percutaneous angioplasty and stent placement is compared with the outcome in patients with renovascular disease treated with medical treatment only. Additionally, the impact of oxidative stress and eosinophil count in peripheral blood as predictors of renal function deterioration in renovascular disease irrespective of treatment is investigated.


METHODS
Eighty-two patients with renovascular disease were enrolled into a follow-up study (47.5+/-35.4 months). Thirty-six patients (group 1) underwent revascularization and stenting, and 46 patients (group 2) were on medical treatment only. In all patients, serum creatinine concentration, eosinophil count (EO) in peripheral blood, and estimation of oxidative stress with dROMs test were determined before and at the end of the follow-up.


RESULTS
In revascularized patients (group 1), hypertension was cured in 11.1% and improved in 66.6%. Renal function improved in 30.5% and worsened in 36.2% of patients. In the medical treatment arm (group 2), hypertension improved in 71.4% of the patients. Renal function remained stable in 69.8% of patients and worsened in 30.2%. Cox regression analysis showed that higher levels of eosinophil count and higher levels of ROS, irrespectively of mode of treatment, were associated with renal function deterioration (i.e., serum creatinine increase more than 20% during follow-up).


CONCLUSIONS
Revascularization was not superior to medical treatment in renal survival but had a greater positive impact on blood pressure control. Eosinophil count and oxidative stress were the stronger predictive factors for serum creatinine increase.
Ziakka
Stavroula
S
Nephrology Department,Corgialenio-Benakio Hospital, Athens, Greece.
Ursu
Michaela
M
Poulikakos
Dimitris
D
Papadopoulos
Christophoros
C
Karakasis
Filippos
F
Kaperonis
Nikolaos
N
Papagalanis
Nicolas
N
D000368:Aged; D017130:Angioplasty; D050197:Atherosclerosis / Q000150:complications / Q000378:metabolism* / Q000601:surgery / Q000628:therapy; D001794:Blood Pressure; D018450:Disease Progression; D004802:Eosinophilia / Q000150:complications*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006978:Hypertension, Renovascular / Q000209:etiology / Q000378:metabolism* / Q000601:surgery / Q000628:therapy; D007677:Kidney Function Tests; D008297:Male; D008875:Middle Aged; D018384:Oxidative Stress; D011446:Prospective Studies; D017382:Reactive Oxygen Species / Q000097:blood; D015607:Stents; D016896:Treatment Outcome
D017382:Reactive Oxygen Species