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Albuminuria predicts renal functional outcome after intervention in atheromatous renovascular disease
J M Halimi1, J Ribstein, G Du Cailar
1Department of Medicine, Hôpital Lapeyronie, Montpellier, France.
Insights
Albuminuria predicts kidney function after revascularization for atheromatous renovascular disease. High albuminuria indicates damage, suggesting poorer outcomes post-intervention for renal failure.
Area of Science:
- Nephrology
- Cardiovascular Medicine
- Interventional Radiology
Background:
- Atheromatous renovascular disease is a growing cause of renal failure.
- Predicting renal function outcomes after intervention remains challenging.
Purpose of the Study:
- To identify predictors of renal functional outcomes after revascularization in patients with atheromatous renovascular disease.
Main Methods:
- Prospective assessment of 23 patients undergoing percutaneous transluminal renal angioplasty or surgery.
- Evaluated glomerular filtration rate and renal hemodynamics.
- Analyzed predictors including urinary albumin excretion and renal plasma flow.
Main Results:
- Glomerular filtration rate improved in 6, deteriorated in 5, and remained unchanged in 12 patients.
- Pre-intervention urinary albumin excretion inversely correlated with GFR response.
- Albuminuria predicted long-term GFR stability, with proteinuric patients showing further deterioration.
Conclusions:
- Urinary albumin excretion is a reliable predictor of renal functional outcome after intervention for atheromatous renovascular disease.
- Albuminuria indicates intra-renal vascular and glomerular damage, influencing post-intervention prognosis.
Background:
Atheromatous renovascular disease is increasingly recognized as a cause of renal failure; however, the benefit of intervention on renal function outcome cannot be clearly anticipated.
Objective:
To identify reliable predictor(s) of renal functional outcome after revascularization in patients with atheromatous renovascular disease.
Design:
The effect of percutaneous transluminal renal angioplasty (n = 5) or surgery (n = 18) on glomerular filtration rate ([99mTc]-diethylene triaminopenta-acetic acid clearance) and renal haemodynamics was prospectively assessed in 23 patients with atheromatous renovascular disease (unilateral occlusion in five, unilateral stenosis in four, stenosis of a single kidney in five, unilateral occlusion associated with contralateral stenosis in six, bilateral stenosis in three). Renal function was altered in 18 patients.
Results:
At early follow-up study (5 +/- 1 months) after intervention, glomerular filtration rate improved (i.e. increased by more than 15%) in six patients, deteriorated in five and remained unchanged in 12 patients. The change in glomerular filtration rate associated with intervention was inversely correlated with the pre-intervention level of urinary albumin excretion and positively with the change in effective renal plasma flow after intervention. Stepwise regression analysis showed that pre-intervention urinary albumin excretion was the only predictor of the glomerular filtration rate response to intervention. At late follow-up study (32 +/- 6 months, n = 13), glomerular filtration rate was stable compared with early follow-up determination in non-proteinuric patients whereas it had deteriorated further in proteinuric patients.
Conclusion:
In patients with atheromatous renovascular disease, albuminuria may be considered as a marker of pre-existing intra-renal vascular and glomerular damage and a reliable predictor of renal functional outcome after intervention.