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Review
. 2013 Sep;22(5):525-30.
doi: 10.1097/MNH.0b013e328363ffe0.

Renovascular hypertension: is there still a role for stent revascularization?

Stephen C Textor  1
Affiliations
Review

Renovascular hypertension: is there still a role for stent revascularization?

Stephen C Textor. Curr Opin Nephrol Hypertens. 2013 Sep.

Abstract

Purpose of review: Management of renovascular hypertension remains controversial and problematic, in part, due to failure of prospective trials to demonstrate added benefit to revascularization.

Recent findings: Effective drug therapy often can achieve satisfactory blood pressure control, although concerns persist of the potential for progressive, delayed loss of kidney function beyond a stenotic lesion. Recent studies highlight benefits of renal artery stenting in subsets of patients including those with recurrent pulmonary edema and those intolerant to blockade of the renin-angiotensin system. Occasional patients with recent deterioration in renal function recover sufficient glomerular filtration rate after stenting to avoid requirements for renal replacement therapy. Emerging paradigms from both clinical and experimental studies suggest that hypoxic injury within the kidney activates inflammatory injury pathways and microvascular rarification that may not recover after technically successful revascularization alone. Initial data suggest that additional measures to repair the kidney, including the use of cell-based therapy, may offer the potential to recover kidney function in advanced renovascular disease.

Summary: Specific patient groups benefit from renal revascularization. Nephrologists will increasingly be asked to manage complex renovascular patients, different from those in randomized trials, that require intensely individualized management.

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Figures

Figure
Figure
Serum creatinine values during a 6 week time period obtained for a 62 y.o. diabetic patient with morbid obesity. The rise in creatinine to 2.6 mg/dL had been attributed to diabetes, hypertension and obesity, leading to creation of an arterio-venous dialysis fistula as part of chronic kidney disease (CKD) management. After hospitalization for accelerated hypertension, pulmonary edema and worsening renal failure, she was identified as having a solitary functioning kidney with high-grade renal artery stenosis. Renal revascularization after withholding ACE inhibition led to a decline in creatinine to stable levels of 1.7 mg/dL, now stable for two years. For such patients, renal revascularization can offer recovery and stabilization of kidney function, allow therapy with ACE inhibition, and improve survival.
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References

    1. Textor SC. Issues in renovascular disease and ischemic nephropathy: Beyond ASTRAL. Curr Opin Nephrol Hyper. 2011;20:139–145. - PubMed
    1. Foy A, Ruggiero NJ, Filippone EJ. Revascularization in renal artery stenosis. Cardiology in review. 2012;20(4):189–193. - PubMed
    1. Escobar GA, Campbell DN. Randomized trials in angioplasty and stenting of the renal artery: tabular review of the literature and critical analysis of their results. Ann Vasc Surg. 2012;26(3):434–442. Thoughtful, current summary of the prospective trials in renal revascularization, including those with balloon angioplasty and the stenting trials. The authors delineate the entrance criteria, exclusions and caveats in interpretation needed to apply these data to patients. - PubMed
    1. Kumbhani DJ, Bavry AA, Harvey JE, et al. Clinical outcomes after percutaneous revascularization versus medical management in patients with significant renal artery stenosis: a meta-analysis of randomized controlled trials. Am Heart J. 2011;161:622–630. - PubMed
    1. van den Berg DT, Postma CT, van der Wilt GJ, Riksen NP. The efficacy of renal angioplasty in patients with renal artery stenosis and flash oedema or congestive heart failure: a systematic review. European Journal of Heart Failure. 2012;14(7):773–781. Literature review of trials reports related to renal artery stenting in patients with congestive heart failure and/or episodic pulmonary edema. - PubMed

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