title: Fifteen years' experience of treating atherosclerotic renal artery stenosis by interventional nephrologists in India.
abstract: Atherosclerotic renal artery stenosis (ARAS) is an important cause of kidney disease, accelerated hypertension (HTN), and its treatment is controversial. Our aim was to evaluate the outcomes, safety, and efficacy of percutaneous transluminal angioplasty (PTA) for ARAS. Retrospective analysis of ARAS was performed among 470 angiographies during 1995-2010. Patients with nonatherosclerotic RAS and renal transplant were excluded. We assessed preintervention and postintervention mean arterial pressure (MAP), antihypertensive medications, and renal function to classify as deteriorated (>10% increase in MAP/increase in drugs/>20% reduced GFR), improved (>10% reduced MAP/reduced drugs/>20% increased eGFR), or stabilized (<10% change in MAP/same antihypertensive drugs/<20% change in eGFR) at last follow-up. A total of 220 subjects with mean age of 57.6 ± 10.4 years underwent PTA and/or stenting. The average follow-up was 23.07 ± 21.2 months. Accelerated HTN, HTN onset >50 years, unexplained renal failure, and unilateral small kidney were the most common presentations. In all, 255 significant stenotic lesions in 220 patients (119 unilateral, 66 single functioning kidney, and 35 bilateral) were observed. In total, 255 PTA were performed, including 177 stenting. Technical success was seen in 220/243 (90.5%) subjects. Combined MAP and antihypertensive drugs improved in 154/220 (70%) patients. Renal function improved/stabilized in 175/220 (79.5%). Angioplasty and stenting are relatively safe and feasible tools for control of blood pressure (BP) in ARAS. Angioplasty produced improvement/stabilization of BP in 70%, and the renal function in 79.5% subjects.
authors: Department of Nephrology, Muljibhai Patel Society for Research in Nephro-Urology, Nadiad, Gujarat, India. umapatih@gmail.com
authors: Umapati
authors: U
authors: Hegde
authors: Mohan
authors: M
authors: Rajapurkar
authors: Sishir
authors: S
authors: Gang
authors: Mallikarjun
authors: M
authors: Khanapet
authors: Santosh
authors: S
authors: Durugkar
authors: Kalpesh
authors: K
authors: Gohel
authors: Nagesh
authors: N
authors: Aghor
authors: Anil
authors: A
authors: Ganju
authors: Manish
authors: M
authors: Dabhi
mesh_terms: D000792:Angiography; D000800:Angioplasty, Balloon / Q000379:methods*; D050197:Atherosclerosis / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007194:India; D008297:Male; D008875:Middle Aged; D009398:Nephrology / Q000379:methods*; D012078:Renal Artery Obstruction / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D012189:Retrospective Studies; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome