Renal artery stenosis: Difference between revisions
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'''Renal artery stenosis''' (RAS) is "narrowing or occlusion of the renal artery or arteries. It is due usually to [[atherosclerosis]]; fibromuscular dysplasia; [[thrombosis]]; embolism, or external pressure. The reduced renal perfusion can lead to renovascular hypertension."<ref>{{MeSH}}</ref> Bilateral RAS can lead to [[chronic kidney disease]]. | |||
==Prevalence and epidemiology== | |||
2% of patients underoing coronary angiography in one study had bilateral RAS > 50%.<ref name="pmid15799174">{{cite journal |author=Park S, Jung JH, Seo HS, ''et al'' |title=The prevalence and clinical predictors of atherosclerotic renal artery stenosis in patients undergoing coronary angiography |journal=Heart Vessels |volume=19 |issue=6 |pages=275–9 |year=2004 |month=November |pmid=15799174 |doi= |url= |issn=}}</ref> In this study, 11% had at least unilateral RAS. Of these patients one third do not have a history of [[hypertension]]; however, the rate of hypertension among those with bilateral disease was not reported. | |||
In a second study of patients patients underoing coronary angiography, 4% has bilateral RAS with both lesions > 50% while 1.5% had both lesions > 75%.<ref name="pmid1610982">{{cite journal |author=Harding MB, Smith LR, Himmelstein SI, ''et al'' |title=Renal artery stenosis: prevalence and associated risk factors in patients undergoing routine cardiac catheterization |journal=J. Am. Soc. Nephrol. |volume=2 |issue=11 |pages=1608–16 |year=1992 |month=May |pmid=1610982 |doi= |url=http://jasn.asnjournals.org/cgi/pmidlookup?view=long&pmid=1610982 |issn=}}</ref> Among all the patients with either unilateral or bilateral RAS, half had hypertension. | |||
In an autopsy study, 10 of 15 patients with bilateral RAS (defined as reduction in artery diameter by 50%)<!--(defined as stenosis > 50% of luminal diameter)--> were normotensive by history (defined as diastolic pressure < 100 mm Hg).<ref name="pmid14181143">{{cite journal |author=HOLLEY KE, HUNT JC, BROWN AL, KINCAID OW, SHEPS SG |title=Renal Artery Stenosis. A Clinical-Pathologic Study In Normotensive And Hypertensive Patients |journal=Am. J. Med. |volume=37 |issue= |pages=14–22 |year=1964 |month=July |pmid=14181143 |doi= |url= |issn=}}</ref> Other autopsy studies are Lisa<ref name="lisa">{{cite journal |author=Lisa JR et al|title=Relationship between arterioscherosis of the renal artery and hypertension |journal=Am J Med Sci|volume=205 |issue= |pages=701 |year=1943|month=June }}</ref> who obtained similar results and Blackman<ref name="Blackman">{{cite journal |author=Blackman SS et al|title=Arterioscherosis and partical obstruction of the main renal arteries in association with "essential" hypertension in man|journal=Bull Johns Hopkins Hosp|volume=65 |issue= |pages=353 |year=1939}}</ref> and Richardson<ref name="Richardson">{{cite journal |author=Richardson GO et al|title=Atherosclerosis of the main renal arteries in essential hypertension |journal=The Journal of pathology and bacteriology|volume=55 |issue= |pages=33 |year=1943|month=June }}</ref> who found lower prevalences. | |||
The clinical relevance of these patients is unclear.<ref name="pmid8292176">{{cite journal |author=Spital A |title=Importance of renal artery stenosis in normotensive patients |journal=Ann. Intern. Med. |volume=119 |issue=10 |pages=1054 |year=1993 |month=November |pmid=8292176 |doi= |url=http://www.annals.org/cgi/pmidlookup?view=long&pmid=8292176 |issn=}}</ref> | |||
==Diagnosis== | |||
A [[clinical prediction rule]] ([http://www.annals.org/cgi/content/full/129/9/705/T2 link]) can help diagnose.<ref name="pmid9841602">{{cite journal |author=Krijnen P, van Jaarsveld BC, Steyerberg EW, Man in 't Veld AJ, Schalekamp MA, Habbema JD |title=A clinical prediction rule for renal artery stenosis |journal=Ann. Intern. Med. |volume=129 |issue=9 |pages=705–11 |year=1998 |month=November |pmid=9841602 |doi= |url=http://www.annals.org/cgi/pmidlookup?view=long&pmid=9841602 |issn=}}</ref> | |||
==Treatment== | ==Treatment== | ||
Various treatment options exist and no single therapy is superior to others according to a [[systematic review]].<ref name="pmid17062633">{{cite journal |author=Balk E, Raman G, Chung M, ''et al'' |title=Effectiveness of management strategies for renal artery stenosis: a systematic review |journal=Ann. Intern. Med. |volume=145 |issue=12 |pages=901–12 |year=2006 |month=December |pmid=17062633 |doi= |url=http://www.annals.org/cgi/content/full/145/12/901 |issn=}}</ref> | Various treatment options exist and no single therapy is superior to others according to a [[systematic review]].<ref name="pmid17062633">{{cite journal |author=Balk E, Raman G, Chung M, ''et al'' |title=Effectiveness of management strategies for renal artery stenosis: a systematic review |journal=Ann. Intern. Med. |volume=145 |issue=12 |pages=901–12 |year=2006 |month=December |pmid=17062633 |doi= |url=http://www.annals.org/cgi/content/full/145/12/901 |issn=}}</ref> | ||
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===Surgery=== | ===Surgery=== | ||
Surgical revascularization may benefit patients with serum creatinine above 2.0 mg/dl.<ref name="pmid12009679">{{cite journal |author=Uzzo RG, Novick AC, Goormastic M, Mascha E, Pohl M |title=Medical versus surgical management of atherosclerotic renal artery stenosis |journal=Transplant. Proc. |volume=34 |issue=2 |pages=723–5 |year=2002 |month=March |pmid=12009679 |doi= |url=http://linkinghub.elsevier.com/retrieve/pii/S0041134502026234 |issn=}}</ref> | Surgical revascularization may benefit patients with serum creatinine above 2.0 mg/dl.<ref name="pmid12009679">{{cite journal |author=Uzzo RG, Novick AC, Goormastic M, Mascha E, Pohl M |title=Medical versus surgical management of atherosclerotic renal artery stenosis |journal=Transplant. Proc. |volume=34 |issue=2 |pages=723–5 |year=2002 |month=March |pmid=12009679 |doi= |url=http://linkinghub.elsevier.com/retrieve/pii/S0041134502026234 |issn=}}</ref> | ||
==References== | |||
<references/> | |||
Revision as of 06:40, 3 April 2009
Renal artery stenosis (RAS) is "narrowing or occlusion of the renal artery or arteries. It is due usually to atherosclerosis; fibromuscular dysplasia; thrombosis; embolism, or external pressure. The reduced renal perfusion can lead to renovascular hypertension."[1] Bilateral RAS can lead to chronic kidney disease.
Prevalence and epidemiology
2% of patients underoing coronary angiography in one study had bilateral RAS > 50%.[2] In this study, 11% had at least unilateral RAS. Of these patients one third do not have a history of hypertension; however, the rate of hypertension among those with bilateral disease was not reported.
In a second study of patients patients underoing coronary angiography, 4% has bilateral RAS with both lesions > 50% while 1.5% had both lesions > 75%.[3] Among all the patients with either unilateral or bilateral RAS, half had hypertension.
In an autopsy study, 10 of 15 patients with bilateral RAS (defined as reduction in artery diameter by 50%) were normotensive by history (defined as diastolic pressure < 100 mm Hg).[4] Other autopsy studies are Lisa[5] who obtained similar results and Blackman[6] and Richardson[7] who found lower prevalences.
The clinical relevance of these patients is unclear.[8]
Diagnosis
A clinical prediction rule (link) can help diagnose.[9]
Treatment
Various treatment options exist and no single therapy is superior to others according to a systematic review.[10]
A more recent trial suggests that surgery leads to better patency rates than angioplasty with stenting.[11]
Angioplasty with or without stents
Stenting improves the patency rates after angioplasty according to a randomized controlled trial.[12] This trial found no statistical significance in differences on blood pressure and renal function; however, this study excluded patients with reduced renal function due to their stensoses.
Surgery
Surgical revascularization may benefit patients with serum creatinine above 2.0 mg/dl.[13]
References
- ↑ Anonymous (2024), Renal artery stenosis (English). Medical Subject Headings. U.S. National Library of Medicine.
- ↑ Park S, Jung JH, Seo HS, et al (November 2004). "The prevalence and clinical predictors of atherosclerotic renal artery stenosis in patients undergoing coronary angiography". Heart Vessels 19 (6): 275–9. PMID 15799174. [e]
- ↑ Harding MB, Smith LR, Himmelstein SI, et al (May 1992). "Renal artery stenosis: prevalence and associated risk factors in patients undergoing routine cardiac catheterization". J. Am. Soc. Nephrol. 2 (11): 1608–16. PMID 1610982. [e]
- ↑ HOLLEY KE, HUNT JC, BROWN AL, KINCAID OW, SHEPS SG (July 1964). "Renal Artery Stenosis. A Clinical-Pathologic Study In Normotensive And Hypertensive Patients". Am. J. Med. 37: 14–22. PMID 14181143. [e]
- ↑ Lisa JR et al (June 1943). "Relationship between arterioscherosis of the renal artery and hypertension". Am J Med Sci 205: 701.
- ↑ Blackman SS et al (1939). "Arterioscherosis and partical obstruction of the main renal arteries in association with "essential" hypertension in man". Bull Johns Hopkins Hosp 65: 353.
- ↑ Richardson GO et al (June 1943). "Atherosclerosis of the main renal arteries in essential hypertension". The Journal of pathology and bacteriology 55: 33.
- ↑ Spital A (November 1993). "Importance of renal artery stenosis in normotensive patients". Ann. Intern. Med. 119 (10): 1054. PMID 8292176. [e]
- ↑ Krijnen P, van Jaarsveld BC, Steyerberg EW, Man in 't Veld AJ, Schalekamp MA, Habbema JD (November 1998). "A clinical prediction rule for renal artery stenosis". Ann. Intern. Med. 129 (9): 705–11. PMID 9841602. [e]
- ↑ Balk E, Raman G, Chung M, et al (December 2006). "Effectiveness of management strategies for renal artery stenosis: a systematic review". Ann. Intern. Med. 145 (12): 901–12. PMID 17062633. [e]
- ↑ Balzer KM, Pfeiffer T, Rossbach S, et al (March 2009). "Prospective randomized trial of operative vs interventional treatment for renal artery ostial occlusive disease (RAOOD)". J. Vasc. Surg. 49 (3): 667–74; discussion 674–5. DOI:10.1016/j.jvs.2008.10.006. PMID 19135837. Research Blogging.
- ↑ van de Ven PJ, Kaatee R, Beutler JJ, et al (January 1999). "Arterial stenting and balloon angioplasty in ostial atherosclerotic renovascular disease: a randomised trial". Lancet 353 (9149): 282–6. DOI:10.1016/S0140-6736(98)04432-8. PMID 9929021. Research Blogging.
- ↑ Uzzo RG, Novick AC, Goormastic M, Mascha E, Pohl M (March 2002). "Medical versus surgical management of atherosclerotic renal artery stenosis". Transplant. Proc. 34 (2): 723–5. PMID 12009679. [e]