Kidney Res Clin Pract.  2019 Sep;38(3):336-346. 10.23876/j.krcp.18.0148.

Effects of percutaneous angioplasty on kidney function and blood pressure in patients with atherosclerotic renal artery stenosis

• Kim S
• Kim MJ
• Jeon J
• Jang HR
• Park KB
• Huh W
• Do YS
• Kim YG
• Kim DJ
• Oh HY
• Lee JE

• KMID: 2457725
• DOI: http://doi.org/10.23876/j.krcp.18.0148

Abstract

BACKGROUND
Previous randomized controlled trials of revascularization for atherosclerotic renal artery stenosis (ARAS) were not successful. We investigated the effects of percutaneous transluminal angioplasty with stent insertion (PTA/S) on kidney function and blood pressure (BP) control in patients with ARAS.
METHODS
From 2000 to 2017, 47 subjects who underwent PTA/S for ARAS were identified. A high-risk group was defined, composed of patients having one or more of the following clinical presentations: pulmonary edema, refractory hypertension, and rapid deterioration of kidney function. Subjects who met the criteria of "˜kidney function improvement' or "˜hypertension improvement' after PTA/S were classified as responders.
RESULTS
Twenty-one (44.7%) subjects were classified into the high-risk group. Two subjects (8.0%) in the low-risk group (n = 25) and 5 subjects (27.8%) in the high-risk group (n = 18) showed improvement in kidney function after PTA/S (P = 0.110). In patients with rapid decline of kidney function, estimated glomerular filtration rate improved from 28 (interquartile range [IQR], 10-45) mL/min/1.73 m² to 41 (IQR, 16-67) mL/min/1.73 m² at 4 months after PTA/S, although the difference was not significant (P = 0.084). Regarding BP control, 9 (36.0%) and 14 (77.8%) subjects showed improvement after PTA/S in the low- (n = 25) and high-risk (n = 18) groups, respectively (P = 0.007). In patients with refractory hypertension, the systolic BP dropped from 157 (IQR, 150-164) mmHg to 140 (IQR, 131-148) mmHg at 4 months after PTA/S (P = 0.005). Twenty-five subjects were defined as responders and comprised a significant proportion of the high-risk group (P = 0.004).
CONCLUSION
PTA/S might improve BP control and kidney function in patients with ARAS presenting with high-risk clinical features. The optimal application of PTA/S should be based on individual assessment of the clinical significance of renal artery stenosis.

Keyword

Angioplasty; Blood pressure; Glomerular filtration rate; Renal artery stenosis

MeSH Terms

Angioplasty*
Blood Pressure*
Glomerular Filtration Rate
Humans
Hypertension
Kidney*
Pulmonary Edema
Renal Artery Obstruction*
Renal Artery*
Stents