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Azotemia caused by renal artery stenosis: treatment by percutaneous angioplasty
L G Martin1, W J Casarella, G M Gaylord
1Department of Radiology, Emory University Hospital, Atlanta, GA 30322.
Insights
Renal artery angioplasty improved serum creatinine in 43% of patients with significant renal artery stenosis. Success was higher for bilateral stenosis and mild azotemia, but less effective for severe cases.
Area of Science:
- Nephrology
- Interventional Cardiology
- Vascular Surgery
Background:
- Renal artery stenosis (RAS) can lead to kidney damage and elevated serum creatinine.
- Percutaneous angioplasty is a potential treatment for hemodynamically significant RAS.
Purpose of the Study:
- To evaluate the effectiveness of renal artery angioplasty in patients with azotemia and significant RAS.
- To identify factors influencing the success of angioplasty in improving renal function.
Main Methods:
- Seventy-nine patients with serum creatinine > 1.7 mg/dl and significant RAS underwent renal artery angioplasty.
- Exclusion criteria included non-renal azotemia and contrast-induced nephropathy.
- Serum creatinine levels were monitored for an average of 16 months post-procedure.
Main Results:
- 43% of patients experienced a >20% decline in serum creatinine post-angioplasty.
- Success rates varied by stenosis type: 61% for bilateral, 38% for unilateral with absent contralateral flow, and 38% for unilateral with normal contralateral flow.
- Angioplasty was least successful in patients with creatinine > 4.0 mg/dl (14%), including those on hemodialysis.
Conclusions:
- Renal artery angioplasty is a valuable treatment for mild azotemia and bilateral RAS.
- Angioplasty efficacy is reduced in patients with severe azotemia or unilateral RAS.
- Patient selection is crucial for optimizing outcomes of renal artery angioplasty.
Abstract:
Percutaneous angioplasty of the renal artery was performed in 79 patients who had stable or climbing serum creatinine levels greater than 1.7 mg/dl and hemodynamically significant stenosis of the renal artery. Patients who had nonrenal causes of azotemia, nephropathy caused by iodinated contrast material, or serum creatinine levels that were declining while the patients were receiving medical therapy before angioplasty were excluded from the study. Angioplasty resulted in a significant (greater than 20%) decline in the level of serum creatinine (average, 2.7 mg/dl before to 1.7 mg/dl after) in 43% of these patients during an average follow-up period of 16 months. A significant decrease in the level of serum creatinine was seen in 61% of patients with bilateral stenosis, 38% of patients with unilateral stenosis with absent contralateral renal blood flow, and 38% of patients with unilateral stenosis and normal contralateral renal blood flow. Recapture of lost nephron function was least successful in patients whose levels of serum creatinine were greater than 4.0 mg/dl (14%); this included one (11%) of nine patients who were already on hemodialysis. We conclude that angioplasty of the renal artery can play a major role in the treatment of patients who have mild azotemia and bilateral stenosis of the renal artery. It is less successful in treatment of patients who have severe azotemia and those who have unilateral disease.