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Atherosclerotic ischemic renal disease
1Division of Nephrology, Vanderbilt University Medical Center, Nashville, TN 37205, USA.
Summary
Ischemic nephropathy, often caused by renal artery stenosis, is increasingly recognized as treatable. Advances in screening and interventions like angioplasty improve kidney function outcomes.
Area of Science:
- Nephrology
- Cardiovascular Medicine
- Vascular Surgery
Background:
- Ischemic nephropathy is a recognized clinical entity, primarily caused by atherosclerotic renal artery stenosis.
- This condition is prevalent in aging populations undergoing renal replacement therapy, often with co-existing systemic atherosclerosis and comorbidities.
- Patients increasingly present with advanced disease, diffuse atherosclerosis, and multiple health issues.
Purpose of the Study:
- To review the evolving understanding and management of ischemic nephropathy.
- To highlight advancements in screening, patient selection, and interventional strategies.
- To discuss the pathophysiologic basis of acute and chronic renal ischemia.
Main Methods:
- Review of recent literature on ischemic nephropathy and renal artery stenosis.
- Analysis of outcomes associated with improved screening and interventional approaches.
- Synthesis of pathophysiologic concepts from acute ischemia studies to chronic conditions.
Main Results:
- Improved screening and interventional techniques have led to better outcomes in managing ischemic renal disease.
- Percutaneous transluminal renal angioplasty is a preferred treatment for nonostial renal artery stenosis in some centers.
- Both angioplasty and surgical repair demonstrate benefits for preserving renal function.
Conclusions:
- Ischemic nephropathy is a treatable condition requiring timely diagnosis and intervention.
- Advances in interventional cardiology and surgery offer effective options for renal function salvage.
- Understanding the transition from acute to chronic renal ischemia is crucial for effective management.