Atherosclerotic Renovascular Disease: A KDIGO (Kidney Disease: Improving Global Outcomes) Controversies Conference

被引:28
作者
Hicks, Caitlin W. [1 ]
Clark, Timothy W. I. [2 ]
Cooper, Christopher J. [3 ]
Bhailis, Aine M. de [4 ]
De Carlo, Marco [5 ]
Green, Darren [4 ]
Malyszko, Jolanta [6 ]
Miglinas, Marius [7 ]
Textor, Stephen C. [8 ]
Herzog, Charles A. [9 ,10 ,12 ]
Johansen, Kirsten L. [11 ,13 ]
Reinecke, Holger [14 ]
Kalra, Philip A. [4 ]
机构
[1] Johns Hopkins Univ, Sch Med, Div Vasc Surg & Endovasc Therapy, Baltimore, MD USA
[2] Univ Penn, Dept Radiol, Div Intervent Radiol, Perelman Sch Med, Philadelphia, PA 19104 USA
[3] Univ Toledo, Coll Med & Life Sci, 2801 W Bancroft St, Toledo, OH 43606 USA
[4] Salford Royal Hosp, Dept Renal Med, Stott Lane, Salford M6 8HD, Lancs, England
[5] Azienda Osped Univ Pisana, Cardiothorac & Vasc Dept, Pisa, Italy
[6] Warsaw Med Univ, Dept Nephrol Dialysis & Internal Med, Warsaw, Poland
[7] Vilnius Univ, Ctr Nephrol, Santaros Klinikos, Vilnius, Lithuania
[8] Mayo Clin, Div Nephrol & Hypertens, Rochester, MN USA
[9] Hennepin Healthcare, Chron Dis Res Grp, Hennepin Healthcare Res Inst, Minneapolis, MN USA
[10] Hennepin Healthcare, Div Cardiol, Minneapolis, MN USA
[11] Hennepin Healthcare, Div Nephrol, Minneapolis, MN USA
[12] Univ Minnesota, Dept Med, Minneapolis, MN USA
[13] Univ Minnesota, Div Nephrol, Minneapolis, MN USA
[14] Univ Hosp Munster, Dept Cardiol Coronary & Peripheral Vasc Dis 1, Heart Failure, Munster, Germany
关键词
RENAL-ARTERY STENOSIS; MAGNETIC-RESONANCE ANGIOGRAPHY; GLOMERULAR-FILTRATION-RATE; CHRONIC HEART-FAILURE; HIGH BLOOD-PRESSURE; FIBROMUSCULAR DYSPLASIA; SURGICAL REVASCULARIZATION; MEDICAL THERAPY; BALLOON ANGIOPLASTY; VASCULAR-DISEASE;
D O I
10.1053/j.ajkd.2021.06.025
中图分类号
R5 [内科学]; R69 [泌尿科学(泌尿生殖系疾病)];
学科分类号
1002 ; 100201 ;
摘要
The diagnosis and management of atherosclerotic renovascular disease (ARVD) is complex and controversial. Despite evidence from the ASTRAL (2009) and CORAL (2013) randomized controlled trials showing that percutaneous renal artery revascularization did not improve major outcomes compared with best medical therapy alone over 3-5 years, several areas of uncertainty remain. Medical therapy, including statin and antihypertensive medications, has evolved in recent years, and the use of renin-angiotensin-aldosterone system blockers is now considered the primary means to treat hypertension in the setting of ARVD. However, the criteria to identify kidneys with renal artery stenosis that have potentially salvageable function are evolving. There are also data suggesting that certain high-risk populations with specific clinical manifestations may benefit from revascularization. Here, we provide an overview of the epidemiology, diagnosis, and treatment of ARVD based on consensus recommendations from a panel of physician experts who attended the recent KDIGO (Kidney Disease: Improving Global Outcomes) Controversies Conference on central and peripheral arterial diseases in chronic kidney disease. Most focus is provided for contentious issues, and we also outline aspects of investigation and management of ARVD that require further research.
引用
收藏
页码:289 / 301
页数:13
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