Atherosclerotic Renal Artery Stenosis: Should we Intervene Earlier?

被引：27
作者：
de Leeuw, Peter W. [1 ,2 ]
Postma, Cor T. [3 ]
Spiering, Wilko [4 ]
Kroon, Abraham A. [1 ]
机构：
[1] Maastricht Univ, Med Ctr, Dept Med, Maastricht, Netherlands
[2] Zuyderland Med Ctr, Dept Med, Sittard Geleen, Heerlen, Netherlands
[3] Univ Med Ctr Nijmegen St Radboud, Dept Med, Nijmegen, Netherlands
[4] Univ Utrecht, Univ Med Ctr Utrecht, Dept Vasc Med, Utrecht, Netherlands
来源：
CURRENT HYPERTENSION REPORTS | 2018年 / 20卷 / 04期
关键词：
Atherosclerosis; Renovascular hypertension; Cardiovascular complications; Renal function; Renal artery stenosis; Intervention; TRANSLESIONAL PRESSURE-GRADIENTS; RENOVASCULAR DISEASE; NATURAL-HISTORY; VASCULAR-DISEASE; HYPERTENSION; REVASCULARIZATION; ANGIOGRAPHY; PREVALENCE; DYSFUNCTION; ULTRASOUND;
D O I：
10.1007/s11906-018-0829-3
中图分类号：
R6 [外科学];
学科分类号：
1002 ; 100210 ;
摘要：
Purpose of Review Randomized trials have failed to show clinical benefit in patients with atherosclerotic renal artery stenosis who were treated with angioplasty with or without stenting. However, these studies were done in patients with a high-grade stenosis. This paper examines whether there are arguments to consider patients with low-grade stenosis for angioplasty. Recent Findings Patients with low-grade (< 50%) atherosclerotic renal artery stenosis have an excess risk for cardiovascular and renal complications. This could be related to inflammatory factors being generated by the stenotic kidney. Moreover, even a kidney with low-grade stenosis clears less or produces more of the natural nitric oxide inhibitor ADMA. Summary Patients with low-grade atherosclerotic renal artery stenosis have an increased risk for a variety of complications. In addition, the abnormality is progressive. There is a case for setting up a prospective trial to examine whether angioplasty confers benefit in patients with low-grade renal artery stenosis.
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页数：7
相关论文
共 39 条
[1]   ACUTE ANGIOTENSIN-II-MEDIATED RESTORATION OF DISTAL RENAL-ARTERY PRESSURE IN RENAL-ARTERY STENOSIS AND ITS RELATIONSHIP TO THE DEVELOPMENT OF SUSTAINED ONE-KIDNEY HYPERTENSION IN CONSCIOUS DOGS [J].
ANDERSON, WP ;
KORNER, PI ;
JOHNSTON, CI .
HYPERTENSION, 1979, 1 (03) :292-298
[2]   ACUTE RENAL HEMODYNAMIC AND RENIN-ANGIOTENSIN SYSTEM RESPONSES TO GRADED RENAL-ARTERY STENOSIS IN THE DOG [J].
ANDERSON, WP ;
JOHNSTON, CI ;
KORNER, PI .
JOURNAL OF PHYSIOLOGY-LONDON, 1979, 287 (FEB) :231-245
[3]  
[Anonymous], AHRQ PUBLICATION
[4]   Risk of atrophy in kidneys with atherosclerotic renal artery stenosis [J].
Caps, MT ;
Zierler, RE ;
Polissar, NL ;
Bergelin, RO ;
Beach, KW ;
Cantwell-Gab, K ;
Casadei, A ;
Davidson, RC ;
Strandness, ED .
KIDNEY INTERNATIONAL, 1998, 53 (03) :735-742
[5]   Prospective study of atherosclerotic disease progression in the renal artery [J].
Caps, MT ;
Perissinotto, C ;
Zierler, RE ;
Polissar, NL ;
Bergelin, RO ;
Tullis, MJ ;
Cantwell-Gab, K ;
Davidson, RC ;
Strandness, DE .
CIRCULATION, 1998, 98 (25) :2866-2872
[6]  
Cheung CM, 2002, J AM SOC NEPHROL, V13, P149, DOI 10.1681/ASN.V131149
[7]  
Conlon PJ, 1998, J AM SOC NEPHROL, V9, P252
[8]   Assessment of renal artery stenosis severity by pressure gradient measurements [J].
De Bruyne, Bernard ;
Manoharan, Ganesh ;
Pijls, Nico H. J. ;
Verhamme, Katia ;
Madaric, Juraj ;
Bartunek, Jozef ;
Vanderheyden, Marc ;
Heyndrickx, Guy R. .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 2006, 48 (09) :1851-1855
[9]   Clinical significance of low-grade renal artery stenosis [J].
Dechering, D. G. ;
Kruis, H. M. E. ;
Adiyaman, A. ;
Thien, Th. ;
Postma, C. T. .
JOURNAL OF INTERNAL MEDICINE, 2010, 267 (03) :305-315
[10]   Assessment of renal artery stenosis: side-by-side comparison of angiography and duplex ultrasound with pressure gradient measurements [J].
Drieghe, Benny ;
Madaric, Juraj ;
Sarno, Giovanna ;
Manoharan, Ganesh ;
Bartunek, Jozef ;
Heyndrickx, Guy R. ;
Pijls, Nico H. J. ;
De Bruyne, Bernard .
EUROPEAN HEART JOURNAL, 2008, 29 (04) :517-524
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