Related Experiment Videos
Renovascular hypertension: the small kidney updated
G G Geyskes1, H Y Oei, J Klinge
1Department of Nephrology and Hypertension, University Hospital, Utrecht, The Netherlands.
The Quarterly Journal of Medicine
|March 1, 1988
Summary
Treating renovascular hypertension in patients with a poorly functioning small kidney often involves percutaneous transluminal angioplasty and/or nephrectomy. This approach successfully achieved normal blood pressure in most patients without significant loss of kidney function.
Area of Science:
- Nephrology
- Cardiovascular Medicine
- Interventional Radiology
Background:
- Renovascular hypertension (RVH) in patients with a poorly perfused, small kidney presents a complex therapeutic challenge.
- Identifying the specific arterial pathology (occlusion vs. stenosis) is crucial for treatment planning.
- Assessing contralateral kidney involvement is essential for preserving overall renal function.
Purpose of the Study:
- To evaluate the efficacy of percutaneous transluminal angioplasty (PTA) and nephrectomy in managing RVH associated with a small, poorly functioning kidney.
- To determine the impact of these interventions on blood pressure control and renal function.
- To analyze treatment outcomes based on the type of arterial lesion and laterality.
Main Methods:
- Retrospective analysis of 57 patients with RVH and a small kidney (<25% 131I-hippurate uptake).
- Arteriography to identify renal artery occlusion or stenosis in the small and contralateral kidneys.
- Interventions included PTA for stenosis and nephrectomy for non-dilated or occluded arteries.
- Blood pressure and renal function were monitored post-intervention.
Main Results:
- PTA successfully treated contralateral kidney stenosis in most cases and small kidney stenosis in 22/28 patients, leading to improved blood pressure in 12.
- Nephrectomy of the small kidney improved blood pressure control in 17 patients with unilateral disease unsuitable for PTA.
- Combined PTA and nephrectomy improved renal function in 10 patients with bilateral lesions.
- Overall, 48/57 patients achieved normotension post-treatment, with preserved renal function.
Conclusions:
- Percutaneous transluminal angioplasty, when feasible, followed by nephrectomy and/or medication, is an effective strategy for managing renovascular hypertension in patients with a small, poorly functioning kidney.
- This combined approach can achieve normotension without significant deterioration of renal function or serious complications in the majority of patients.
- Histological findings of infarcts or cholesterol emboli suggest underlying atherosclerotic disease contributing to the renal artery pathology.