P3570Bilateral renal artery stenting is effective method for the treatment of uncontrolled hypertension and renal function

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
J Uzokov ◽  
A L Alyavi ◽  
B A Alyavi ◽  
S A Iskhakov ◽  
D D Payziev
Keyword(s):  
Blood Pressure ◽  
Renal Function ◽  
Serum Creatinine ◽  
Renal Artery ◽  
Uncontrolled Hypertension ◽  
Renal Artery Stenting ◽  
Group I ◽  
Group Ii ◽  
Bilateral Stenting

Abstract Background Renal artery (RA) stenosis is one of the main causes of severe uncontrolled primary hypertension among population. Aim of the study was to investigate effectiveness of stent replacement in renal arteries and influence it on renal function in uncontrolled hypertensive patients (UHP) with pharmacotherapies. Methods 86 consecutive UHP with renal etiology confirmed by angiography were enrolled in this study. Mean age of the patients was 43.2±12.5 years (aged 31–59 years, male=46%). Blood pressure, serum creatinine, microalbuminuria were assessed at baseline and after the intervention and during the follow-up for statistics. Mean follow-up was 2.0±1.0 years. Results Total of 128 hemodynamically significant renal artery stenosis were treated by implanting stents in all 86 patients. Among them in 42 patients were performed bilateral stenting (Group I) and 44 patients unilateral stenting (Group II). Systolic and diastolic blood pressure (SBP, DBP) decreased in both groups during the follow-up, however it was noted that only SBP were decreased significantly in Group I (unilateral stenting) whilst reduction in DBP not significantly when compared to Group II. Mean reduction in SBP was from 165.0±20.5 mmHg to 130.4±14.0 mmHg in Group I vs. from 158.0±22.0 to 135.0±15.0 mmHg in Group II (P=0.003 when compared two groups) and in DBP was from 95.0±11.2 mmHg to 83.4±8.0 mmHg in Group I vs. from 93.0±10.0 to 82.0±7.5 mmHg in Group II (P>0.05 when compared two groups). Serum creatinine levels were reduced from 123.0±49.0 μmol/l to 85.4±30.6 μmol/l in Group I vs 116.8±51.2 μmol/l to 86.9±35.5 μmol/l (P<0.05 when compared two groups). Significantly reduction in MAU were noted in both groups (P<0.05) but when compared two groups there were no significant changes in reduction. Conclusion Renal artery stenting is effective method for the treatment of UHP and may improve outcomes of the patients. Bilateral stenting seems to be more effective in blood pressure and serum creatinine control in UHP.

scholarly journals Renal Artery Stenting Associated With Improvement in Renal Function and Blood Pressure Control in Long-Term Follow-Up

2016 ◽  
Vol 41 (3) ◽  
pp. 278-287 ◽  
Author(s):  
Krzysztof Milewski ◽  
Wojciech Fil ◽  
Piotr Buszman ◽  
Małgorzata Janik ◽  
Wojciech Wanha ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Renal Function ◽  
Renal Artery ◽  
Blood Pressure Control ◽  
Pressure Control ◽  
Renal Artery Stenting ◽  
Long Term Follow Up

scholarly journals To Stent or Not to Stent? This is the Renal Artery Stenosis Question

2014 ◽  
Vol 6 (1) ◽  
pp. 1-2
Author(s):  
Michael Doumas ◽  
Konstantinos Tziomalos ◽  
Vasilios G. Athyros
Keyword(s):  
Blood Pressure ◽  
Renal Function ◽  
Renal Artery ◽  
Renal Artery Stenosis ◽  
Medical Therapy ◽  
Clinical Benefit ◽  
Optimal Medical Therapy ◽  
Renal Angioplasty ◽  
Renal Artery Stenting

A few days ago (Nov 18, 2013) the results of the large prospective 􀀃􀀇􀀑􀀉􀀌􀀐􀀕􀀇􀀒􀀈􀀔􀀍􀀇􀀑􀀁 􀀅􀀔􀀓􀀈􀀐􀀎􀀊􀀒􀀁 􀀌􀀏􀀁 􀀆􀀊􀀏􀀇􀀍􀀁 􀀂􀀓􀀋􀀊􀀑􀀐􀀖 􀀒􀀈􀀍􀀊􀀑􀀐􀀓􀀌􀀈􀀁 􀀄􀀊􀀒􀀌􀀐􀀏􀀒􀀁 􀀗􀀃􀀅􀀆􀀂􀀄􀀘􀀁 􀀓􀀑􀀌􀀇􀀍 were presented and published. CORAL enrolled 947 participants who had atherosclerotic renal artery stenosis (ARAS), 􀀂 60% and either uncontrolled systolic hypertension despite treatment with 􀀂 2 anti-hypertensive drugs or stage 3 chronic kidney disease (CKD) [1]. CORAL randomly assigned patients to medical therapy plus renal-artery stenting or medical therapy alone. The median follow-up period was 43 months and the primary endpoint was a composite of death from cardiovascular disease (CVD) or renal causes, myocardial infarction (MI), stroke, congestive heart failure, progression of renal insufficiency, or need for renal replacement therapy. Results showed that the addition of renal-artery stenting to thorough multifactorial medical therapy did not contribute a significant clinical benefit with respect to the prevention of CVD events or renal function deterioration. Adverse CVD or renal events occurred in 35.1% of patients who received stenting and 35.8% of those on medical therapy alone (p=0.58) [1]. Thus, the authors concluded that renal artery stenting was not superior to optimal medical therapy alone for moderately severe ARAS [1]. The results of CORAL have a direct impact on clinical practice questioning the need for renal artery stenting in patients managed with optimal medical therapy. The message seems to be very simple. If patients have ARAS and high blood pressure, they need a very aggressive comprehensive medical therapy before considering any interventional procedure. A recent meta-analysis investigated CVD outcome in patients with ARAS treated either with renal angioplasty or antihypertensive drug therapy [2]. Pooled data from 5 studies (n=1,159 patients) showed that during the 2-year follow-up there were no significant clinical outcome differences between angioplasty and medical therapy [2], both in patients with or without CKD. In another study [3] it was shown that patients with ARAS and normal or near normal renal function (creatinine 􀀁2.0 mg/dl) can be safely treated with effective drug treatment, with a small decrease in GFR. For patients who have atherosclerotic MI, stroke or renal impairment, renal artery stenting may further reduce blood pressure and delay the deterioration or even improve renal function [3]. The Angioplasty and Stenting for Renal Artery Lesions (ASTRAL) trial (n =867) [4], although criticised by some for methodological issues [5], results showed that there were no meaningful clinical benefit from revascularization in patients with ARAS; however considerable risks were present [4]. On the other hand, in patients with renovascular hypertension due to fibromuscular dysplasia (RAFMD) and/or the combination of RAFMD with ARAS, angioplasty is the method of choice and has favourable short- and long-term CVD and renal clinical outcomes [6]. The take away message from all the above is that prior trials showed similar results in mild ARAS; this study established the futility of stenting for a higher severity (moderate severity) of the disease. Substantially severe forms of ARAS will probably have to undergo renal angioplasty with stenting, especially when flash pulmonary oedema occurs [7-9].

scholarly journals Does renal artery stenting impacts left ventricle mass and function, blood pressure values, renal function and cytokine concentration?

2013 ◽  
Vol 34 (suppl 1) ◽  
pp. P5440-P5440
Author(s):  
D. Rzeznik ◽  
T. Przewlocki ◽  
A. Kablak-Ziembicka ◽  
A. Roslawiecka ◽  
A. Kozanecki ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Renal Function ◽  
Left Ventricle ◽  
Renal Artery ◽  
Cytokine Concentration ◽  
Left Ventricle Mass ◽  
Renal Artery Stenting ◽  
And Function

scholarly journals Renal function impairment in Hypothyroidism

2013 ◽  
Vol 6 (1) ◽  
pp. 19-25
Author(s):  
HS Chaudhury ◽  
KK Raihan ◽  
MN Uddin ◽  
SM Ansari ◽  
M Hasan ◽  
...  
Keyword(s):  
Renal Function ◽  
Serum Creatinine ◽  
Total Cholesterol ◽  
Impaired Renal Function ◽  
Ldl Cholesterol ◽  
Colorimetric Method ◽  
Group I ◽  
Increased Risk ◽  
The Mean ◽  
Group Ii

Background: Hypothyroidism is an important public health problem in Bangladesh. It is associated with increased risk for atherosclerosis and other complications. The frank development of hypothyroidism is associated with metabolic derangements including dyslipidemia- which is an etiopathologic factor for development of renal impairment. This study was to evaluate whether hypothyroidism is associated with impaired renal function. Methods: Using a cross sectional analytical study design, a total of 111 subjects attending Out Patient Department, Center for Nuclear Medicine and Ultrasound, Bogra Medical College during January 2007 to December 2007 were included purposively. Eighty newly diagnosed hypothyroid patients (Group I) and 31 healthy adults (Group II) were enrolled in this study. Serum thyroid stimulating hormone and serum free thyroxine were assayed by radioimmunoassay. Serum fasting lipid profile, serum creatinine and serum uric acid were estimated by enzymatic colorimetric method. Estimated GFR was calculated using MDRD equation. Results: The mean (±SD) age of in Group I and Group II were 35.59 (±6.91) and 37.35 (±2.78) years and were comparable. In Group I, there were 66 females and 14 males. In Group II, there were 16 females and 15 males. The mean BMI was 25.49 ±2.17 kg/m2 in Group I and 24.24 ±1.99 kg/m2 in Group II. The mean (±SD) Serum total-cholesterol, LDL- cholesterol and tryacylglycerol in Group I were significantly higher than that in Group II. Serum HDL cholesterol in Group I was significantly lower than that in Group II (p<0.001). The mean (±SD) serum creatinine was significantly higher in Group I than Group II (P<0.001). The estimated glomerular filtration rate (eGFR) was lower in Group I compared to Group II (p=0.011). In Group I (Hypothyroid), there were significant correlations of BMI, S Total-Cholesterol, S HDLCholesterol, S LDL-Cholesterol, S triglycerides and S creatinine with serum TSH level. In Group I (Hypothyroid), there were significant positive correlations of BMI and TSH with serum creatinine. Conclusions: Hypothyroidism is associated with dyslipidemia, hyperuricemia and impaired renal function. Therefore, patients presenting with these biochemical abnormalities are recommended to be investigated for hypothyroidism and vice versa. DOI: http://dx.doi.org/10.3329/bjmb.v6i1.13283 Bangladesh J Med Biochem 2013; 6(1): 19-25

Stenting zur Erhaltung der Nierendurchblutung bei akuter Aortendissektion: Implantation und Verlauf

VASA ◽  
2000 ◽  
Vol 29 (2) ◽  
pp. 138-140 ◽  
Author(s):  
Behrendt ◽  
Do ◽  
Baumgartner ◽  
Triller ◽  
Kniemeyer ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Renal Function ◽  
Serum Creatinine ◽  
Renal Artery ◽  
Stent Implantation ◽  
Duplex Ultrasound ◽  
Renal Arteries ◽  
Type B ◽  
Type B Dissection

Two patients with renal artery involvement in type B dissection of the aorta were treated by percutaneous stent implantation. Both of them were hypertensive and showed increasing serum creatinine levels. After stent implantation in the renal arteries blood pressure and renal function improved, and the renal arteries were patent in duplex ultrasound 15 and 30 months after treatment respectively.

Multifactorial evaluation of blood pressure fall upon hospitalization in essential hypertensive patients

1987 ◽  
Vol 73 (2) ◽  
pp. 135-141 ◽  
Author(s):  
Hikaru Nishimura ◽  
Akinori Nishioka ◽  
Shinichiro Kubo ◽  
Michihiro Suwa ◽  
Masaya Kino ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Renal Function ◽  
Multivariate Analysis ◽  
Systolic Blood Pressure ◽  
Left Ventricular ◽  
Lower Systolic Blood Pressure ◽  
Group I ◽  
Blood Pressure Fall ◽  
Group Ii ◽  
Pressure Fall

1. Studies were prospectively performed on 72 hospitalized patients with essential hypertension. Blood pressure was normalized within 1 week of admission in 33 patients (group I), but did not decrease in 39 patients (group II). To determine the factors that differentiate group I from group II, cardio-renal haemodynamic and endocrinological indices were evaluated using multivariate analysis. 2. Systolic, diastolic and mean blood pressures on admission were higher in group II (P < 0.001), whose optic fundi showed more severe changes (P < 0.001). Although group II had greater left ventricular posterior wall thickness (P < 0.02), left ventricular mass index (P < 0.05) and systemic vascular resistance (P < 0.01) on echocardiography, their cardiac index and ejection fraction were comparable with those of group I. 3. Renal blood flow (P < 0.05) and glomerular filtration rate (P < 0.01) were lower in group II than in group I. Renal vascular resistance was more elevated (P < 0.01) in group II than in group I. 4. After severe sodium depletion and ambulation, group I showed a greater increase in plasma noradrenaline and adrenaline (P < 0.05). On multivariate analysis, those with lower systolic blood pressure, better renal function and more reactive sympathetic nervous system were discriminated as group I. 5. These data suggest that group I patients have lower systolic blood pressure on admission, greater sympathetic reactivity and better renal function, all of which contribute to their spontaneous blood pressure fall after admission.

scholarly journals Long-term mortality after renal artery stenting in patients with severe atherosclerotic renal artery stenosis and high-risk clinical manifestations

2021 ◽  
Author(s):  
M I Dregoesc ◽  
S D Bolboacă ◽  
P M Doroltan ◽  
M Istrate ◽  
M C Marc ◽  
...  
Keyword(s):  
Blood Pressure ◽  
High Risk ◽  
Renal Artery ◽  
Renal Artery Stenosis ◽  
Clinical Manifestations ◽  
Artery Stenosis ◽  
Uncontrolled Hypertension ◽  
Renal Artery Stenting ◽  
Long Term Mortality

Abstract Background Atherosclerotic renal artery stenosis is a risk factor for cardiovascular death. Observational studies support the benefit of renal revascularization on outcomes in selected patients with high-risk clinical manifestations. In this context, we evaluated the factors associated with long-term mortality after renal artery stenting in patients with severe renal artery stenosis, impaired kidney function and/or uncontrolled hypertension. Methods The medical records of patients undergoing renal artery stenting between 2004 and 2014 were extracted. Blood pressure and creatinine were recorded at baseline, 24 hours post-stenting and in the one month to one year interval that followed revascularization. Long-term follow-up was performed in March 2020. Results The cohort consisted of 65 patients. Median follow-up was 120 months. In the first year after stenting, less patients had chronic kidney disease (CKD) class 3b – 5 as compared to baseline (35.3 vs. 56.9%, p=0.01). The number of patients with controlled blood pressure after revascularization increased with 69.2% (p&lt;0.001). Long-term all-cause mortality reached 44.6%. Age (OR 1.1; 95%CI 1.0–1.2; p=0.01), male gender (OR 7.9; 95%CI 1.9 – 43.5; p=0.008), post-stenting CKD class 3b-5 (OR 5.8; 95%CI 1.5–27.9; p=0.01), and post-revascularization uncontrolled hypertension (OR 8.9; 95%CI 1.7–63.5; p=0.01) were associated with long-term mortality independent of diabetes mellitus and coronary artery disease. Conclusion Improved CKD class and blood pressure were recorded in the first year after renal artery stenting in patients with severe renal artery stenosis and high-risk clinical manifestations. The lack of improvement in kidney function and blood pressure was independently associated with long-term mortality.

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