Stenting of renal artery stenosis: is it beneficial in chronic renal failure?

The utility of renal artery stenting (RS) in preserving renal function (RF) is not well established. Our prospective study aimed to examine the clinical effects of RS in patients with proximal renal artery stenosis and chronic renal failure (CRF).

Fifty-two patients, with atherosclerotic renal artery stenosis (ARAS) and renal impairment underwent successful monolateral (33 patients) or global RS (19 patients: six bilateral stenting, two surgical solitary kidney and 11 functional solitary kidney). Patients were considered eligible if they had at least a mild renal impairment (serum creatinine (Cr) >1.5 mg/dL). To assess a significant change in RF, we compared the slopes of the regression lines derived from the reciprocal of Cr vs. time, plotted before and after stenting. Patients had a median post-procedure follow-up of 24 months (range 9-54).

Before stenting all patients exhibited a negative slope, indicating progressive renal failure. After stenting the slopes became positive in eight patients (15.5%), indicating a significant improvement in RF; in 31 patients (59.5%) the slopes were not significantly different from 0 and were associated with a stable RF, while 13 patients (25%) presented negative slopes and showed a continuous reduction in RF. Previous serum Cr, initial diameter of the treated kidney, vascular resistive index, and mono vs. global stenting were not significantly associated to post stenting RF.

RS appears to be associated with RF stabilization in the majority of patients with CRF.