title: Renal artery stenosis: to intervene, or not to intervene, "that is the question".
abstract: Renal artery stenosis (RAS) due to atherosclerosis continues to be a major cause of secondary hypertension. It can also lead to renal dysfunction due to ischemic nephropathy. While major clinical trials have emphasized that medical management should be preferred over angioplasty and stenting for the treatment of renal artery stenosis, clinical scenarios continue to raise doubts about the optimal management strategy. Herein, we present two cases that were admitted with hypertensive emergency and renal function deterioration. Medical therapy failed to control the blood pressure and in one patient, renal failure progressed to a point where renal replacement therapy was required. Both patients underwent angioplasty (for >90% stenosis) and stent insertion with successful resolution of stenosis by interventional radiology. Postoperatively, blood pressure gradually decreased with improvement in serum creatinine. Dialysis therapy was discontinued. At 4- and 8-month follow-up, both patients continue to do well with blood pressure readings in the 132-145/70-90 mmHg range. This article highlights the importance of percutaneous interventions in the management of atherosclerotic RAS and calls for heightened awareness and careful identification of candidates who would benefit from angioplasty and stent insertion.
authors.affiliation: Division of Nephrology and Hypertension, Department of Radiology and Division of Cardiology, Albany Medical College and Albany Stratton VA Medical Center, Albany, New York.
authors.forename: Syed S
authors.initials: SS
authors.lastname: Haqqie
authors.forename: Anthony
authors.initials: A
authors.lastname: Nappi
authors.forename: Gary
authors.initials: G
authors.lastname: Siskin
authors.forename: Nouman A
authors.initials: NA
authors.lastname: Syed
authors.forename: Ketan
authors.initials: K
authors.lastname: Ghate
authors.forename: Roy O
authors.initials: RO
authors.lastname: Mathew
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Wang
authors.forename: Mandeep S
authors.initials: MS
authors.lastname: Sidhu
authors.forename: Vishesh
authors.initials: V
authors.lastname: Kumar
authors.forename: Loay
authors.initials: L
authors.lastname: Salman
authors.forename: Donna
authors.initials: D
authors.lastname: Merrill
authors.forename: Muhammad U T
authors.initials: MU
authors.lastname: Akmal
authors.forename: Ali
authors.initials: A
authors.lastname: Nayer
authors.forename: Arif
authors.initials: A
authors.lastname: Asif
mesh_terms: D058186:Acute Kidney Injury / Q000209:etiology / Q000628:therapy; D017130:Angioplasty; D050197:Atherosclerosis / Q000150:complications; D005260:Female; D006801:Humans; D006978:Hypertension, Renovascular / Q000209:etiology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011859:Radiography; D012077:Renal Artery / Q000000981:diagnostic imaging; D012078:Renal Artery Obstruction / Q000150:complications / Q000209:etiology / Q000628:therapy*; D017582:Renal Replacement Therapy; D015607:Stents