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Ischemic disease of the kidney: how and why to consider revascularization
1Department of Internal Medicine, University of Texas Southwestern Medical Center at Dallas, USA. jmiddl@mednet.swmed.edu
Insights
Renal artery atherosclerosis obstruction management is complex. This review details non-invasive tests, intervention outcomes, and emphasizes preserving kidney function and glomerular filtration rate.
Area of Science:
- Cardiology
- Nephrology
- Vascular Surgery
Background:
- Atherosclerosis commonly obstructs renal arteries, complicating clinical decisions, especially when hypertension is medically managed.
- Accurate diagnosis, understanding natural history, and intervention outcomes are crucial for managing renal artery obstruction.
- Preserving kidney function and glomerular filtration rate is a primary goal in contemporary hypertension management.
Purpose of the Study:
- To review non-invasive diagnostic tests for renal artery obstruction.
- To analyze the consequences of untreated renal artery obstruction.
- To evaluate surgical and non-surgical interventions for renal artery obstruction, focusing on preserving kidney function.
Main Methods:
- Review of non-invasive diagnostic modalities for renal artery stenosis.
- Analysis of the natural history and clinical consequences of renal artery obstruction.
- Examination of outcomes for interventions including angioplasty, stenting, atherectomy, and bypass surgery.
Main Results:
- Non-invasive tests offer increasing accuracy in diagnosing renal artery obstruction.
- Untreated obstruction can lead to progressive kidney damage and reduced glomerular filtration rate.
- Both surgical and non-surgical interventions demonstrate varying success rates in reversing obstruction and preserving kidney function.
Conclusions:
- A unified approach to renal artery obstruction is necessary, prioritizing kidney function preservation.
- Intervention decisions should be guided by diagnostic accuracy, natural history, and intervention outcomes.
- Maintaining glomerular filtration rate is a key objective in managing renal artery atherosclerosis.
Abstract:
With increasingly accurate non-invasive tests, the clinician frequently discovers obstruction of the renal arteries by atherosclerosis. The decision to reverse this obstruction is not straightforward, particularly when blood pressure can be easily controlled with medications. Proper management of this problem requires knowledge of the accuracy of the diagnosis, the natural history of the disorder, and the outcomes of possible interventions. This review will emphasize the value of a variety of non-invasive tests, the consequences of allowing the arteries to remain obstructed, and the long-term results from reversing renal artery obstruction. Surgical and non-surgical interventions will be examined, including percutaneous angioplasty, angioplasty with wall stenting, surgical atherectomy, and surgical bypass procedures. In contemporary practice hypertension is routinely recognized and aggressively treated regardless of the etiology. Therefore preservation of kidney function is becoming an increasingly important clinical goal. This review will pursue a unified approach to renal artery obstruction and emphasize the goal of preserving glomerular filtration rate.