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Commentary: Shoot the renals!

F C Luft1, C M Gross

  • 1Medical Faculty of the Charité, Franz-Volhard Clinic, HELIOS Klinikum Berlin-Brandenburg, Berlin, Germany. Luft@charite.de

Heart (British Cardiac Society)
|November 16, 2007
PubMed
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Atherosclerotic renal artery stenosis (ARAS) is a growing problem causing hypertension and kidney failure. Current guidelines for revascularization in high-risk patients with ARAS may be ill-advised due to lack of proven benefit.

Area of Science:

  • Cardiology
  • Nephrology
  • Vascular Medicine

Background:

  • Atherosclerotic renal artery stenosis (ARAS) is an increasingly prevalent condition.
  • ARAS can lead to severe hypertension and end-stage renal disease.
  • Patients with ARAS often succumb to cardiovascular or cerebrovascular events rather than renal failure.

Purpose of the Study:

  • To critically evaluate the current guidelines for revascularization in patients with ARAS.
  • To question the unproven efficacy of interventions like stenting and angioplasty for ARAS.

Main Methods:

  • Review of existing literature and clinical guidelines concerning ARAS management.
  • Analysis of the implications of recent American Heart Association guidelines.

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Main Results:

  • The benefits of revascularization (stenting/angioplasty) for ARAS remain unproven.
  • Current guidelines suggest revascularization for a broad population, potentially encompassing most patients with atherosclerosis.
  • The widespread application of these guidelines may be inappropriate given the lack of demonstrated efficacy.

Conclusions:

  • The current approach to managing ARAS, particularly the broad recommendation for revascularization, requires critical reassessment.
  • Further evidence is needed to support the routine use of interventions for ARAS.
  • Guidelines should be more judicious in recommending revascularization for atherosclerotic renal artery stenosis.