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Percutaneous revascularization for ischemic nephropathy: the past, present, and future
Stephen C Textor1, Sanjay Misra, Gustavo S Oderich
1Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN 55905, USA. textor.stephen@mayo.edu
Kidney International
|November 16, 2012
Summary
Renal artery stenting can help preserve kidney function in cases of ischemic nephropathy. However, its benefits for blood pressure and overall kidney function in atherosclerotic renal artery stenosis remain debated, requiring careful patient selection.
Area of Science:
- Nephrology
- Cardiovascular Medicine
- Interventional Radiology
Background:
- Renal artery occlusion poses risks to kidney viability, hypertension, and circulatory congestion.
- Renal artery stenting has evolved to treat ischemic nephropathy and heart failure, with improved safety but persistent hazards.
- Endovascular stent grafts for abdominal aortic aneurysms create new indications for renal artery stenting.
Purpose of the Study:
- To review the evolving role of renal artery stenting in managing kidney disease and cardiovascular conditions.
- To discuss the controversies and limitations of current research on revascularization for atherosclerotic renal artery stenosis.
- To highlight current research directions focusing on kidney injury pathways and repair potential.
Main Methods:
- Review of clinical evolution and indications for renal artery stenting.
- Analysis of prospective randomized trials and their limitations.
- Discussion of studies on renal tissue oxygenation and injury mechanisms.
Main Results:
- Stenting can recover threatened renal function in ischemic nephropathy and aid heart failure management.
- Prospective trials for atherosclerotic renal artery stenosis show controversial or no major benefits, often due to selection bias.
- Severe occlusion leads to hypoxia, inflammation, fibrosis, and irreversible injury, despite some kidney adaptation capacity.
Conclusions:
- Renal artery stenting has expanded indications beyond hypertension, including ischemic nephropathy and protection during aortic aneurysm repair.
- Evidence for routine revascularization in atherosclerotic renal artery stenosis is inconclusive, necessitating critical evaluation of trial data.
- Future research aims to understand irreversible kidney injury and enhance renal repair post-revascularization, guiding nephrologist focus on identifying at-risk kidneys.
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