title: Improvement of renal function after opening occluded atherosclerotic renal arteries.
abstract: Percutaneous transluminal renal angioplasty (PTRA) with stenting has been effective in the control of hypertension, renal function and pulmonary edema caused by atherosclerotic renal artery stenosis (ARAS). However, concerning the viability of renal function, this procedure has not been fully established, especially in the presence of renal atrophy or severe renal parenchymal disease. We report a dramatically improved case of acute renal failure caused by acute worsening ARAS treated by stenting. A 72-year-old female was admitted for accelerated renal dysfunction (serum ceatinine; 1.2-2.3 mg/dl) and hypertension (190/100 mmHg). At 10 days after admission, the patient's serum ceatinine increased to 6.7 mg/dl, her pulmonary edema was exaggerated and hemodialysis was required. Ultrasonography showed bilateral high-echoic kidneys, but no apparent finding of renal artery stenosis (RAS). At day 15, computed tomographic angiography indicated bilateral ostial RAS. Renal angiography demonstrated total occlusion of the right and severe (90%) disease in the left. ARAS was diagnosed by intravascular ultrasonography. The guidewire was inserted in both renal arteries, PTRA with stenting was performed in the right and a stent was directly implanted in the left. Immediately, each kidney enlarged to almost normal size, leading to satisfactory urination. She was released from hemodialysis the next day since her serum creatinine was normal and the pulmonary edema was improved. Although there is still no reliable prognostic factor including resistive index or kidney size, it is important that PTRA with stenting in ARAS should be considered in a case of accelerated renal dysfunction because of the possible improvement.
authors.affiliation: Department of Nephrology, Kyoto University Graduate School of Medicine, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto 606-8507, Japan. h-kanamori@live.jp
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Kanamori
authors.forename: Masanao
authors.initials: M
authors.lastname: Toma
authors.forename: Atsushi
authors.initials: A
authors.lastname: Fukatsu
mesh_terms: D058186:Acute Kidney Injury / Q000175:diagnosis / Q000209:etiology; D000368:Aged; D000800:Angioplasty, Balloon / Q000295:instrumentation / Q000379:methods*; D050197:Atherosclerosis / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D005260:Female; D006801:Humans; D007668:Kidney / Q000098:blood supply / Q000503:physiopathology*; D012077:Renal Artery / Q000000981:diagnostic imaging / Q000503:physiopathology; D012078:Renal Artery Obstruction / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D015607:Stents; D016896:Treatment Outcome; D014463:Ultrasonography