UNILATERAL STENTING OF RENAL ARTERY STENOSIS IN A PATIENT UNDERGOING HEMODIALYSIS TREATMENT IMPROVES RENAL FUNCTION AND DECREASES BLOOD PRESSURE – EIGHT YEARS LONG-TERM RESULTS

Abstract Background It is little known about predictors of systolic (SBP) and diastolic (DBP) blood pressure or renal function (eGFR) improvement in patients with atherosclerotic renal artery stenosis (ARAS) undergoing stent-assisted angioplasty (PTA). Therefore, we aimed to build a prediction scores that would indicate characteristics of patient subsets with ARAS most likely to have clinical improvement following PTA. Methods 201 patients who underwent PTA for ARAS (2003–2018) were categorized as eGFR or SBP/DBP responders based on eGFR increase of ≥11 ml/min/1.73m2, decrease of SBP ≥20mmHg and DBP ≥5mmHg at 12-months following PTA. The remaining patients were classified as non-responders. The performance of logistic regression models were evaluated by basic decision characteristics. Continuous data have been transformed into binary coding with help of operating characteristic (ROC) curve. Predictive models have been constructed for each followed by construction of predictive models in each of 3 categories. Results Logistic regression analysis showed that: baseline SBP>145 mmHg, DBP >82 mmHg, previous myocardial infarction and Renal-Aotric-Ratio >5.1 were independent influencing factors of SBP response, with relative risk percentage shares of 69.8%; 12.1%; 10.9%; and 7.2%, respectively (sensitivity: 82%, specificity: 86.3%, positive (PPV):82% and negative (NPV) predictive values: 86.3%). The DBP decrease prediction model included baseline SBP >145 mmHg and DBP >82 mmHg, the ARAS progression, index kidney length >106 mm, and bilateral PTA with respective shares of 35.0%; 21.8%; 18.2%; 13.3% and 11.8%. (sensitivity: 76%, specificity: 77.8%, PPV: 80.7% and NPV: 72.6%). The eGFR increase was associated with baseline serum creatinine >122 μmol/L but eGFR greater than 30 ml/min/1.73m2, index kidney length >98 mm, end-diastolic velocity in index renal artery, renal resistive index <0.74, and requirement for >3 BP medications, with respective shares of 24.4%; 24.4%; 21.2%; 15% and 15% (sensitivity: 33.3%, specificity: 93.5%, PPV: 65.6% and NPV: 78.9%). Conclusions Current study identified clinical characteristics of patients who most likely to respond to PTA for ARAS. The sutability of the score should be verified in a prospective cohort of patients referred to PTA of ARAS Funding Acknowledgement Type of funding source: None

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LONG TERM FOLLOW UP OF HYPERTENSIVE PATIENTS WITH ATHEROSCLEROSIS RENAL ARTERY STENOSIS AFTER PERCUTANEOUS RENAL ARTERY ANGIOPLASTY OR STENTING: BLOOD PRESSURE OUTCOME: 4B.05

Journal of Hypertension ◽

10.1097/01.hjh.0000378850.53880.bd ◽

2010 ◽

Vol 28 ◽

pp. e210 ◽

Cited By ~ 1

Author(s):

E Daghini ◽

M Sanna ◽

D Versari ◽

I Di Paco ◽

L Ghiadoni ◽

...

Keyword(s):

Blood Pressure ◽

Renal Artery ◽

Renal Artery Stenosis ◽

Artery Stenosis ◽

Hypertensive Patients ◽

Long Term Follow Up

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Long-Term Clinical Outcomes of Patients with no-significant of Transplanted Renal Artery Stenosis

10.21203/rs.3.rs-388038/v1 ◽

2021 ◽

Author(s):

Manoela Linhares Machado Barteczko ◽

Henry Campos Orellana ◽

Gustavo Rocha Feitosa Santos ◽

Attílio Galhardo ◽

Gabriel Kanhouche ◽

...

Keyword(s):

Blood Pressure ◽

Kidney Transplantation ◽

Renal Artery ◽

Renal Artery Stenosis ◽

Deceased Donor ◽

Vascular Complication ◽

Artery Stenosis ◽

One Year

Abstract Background: Transplant Renal Artery Stenosis (TRAS) is the main vascular complication of kidney transplantation. For research and treatment purposes, several authors consider critical renal artery stenosis to be greater than 50%, and percutaneous intervention is indicated in this scenario. However, there are no reports in the current literature on the evolution of patients with less than 50% stenosis.Method: Retrospective study includes data from all patients that were submitted to kidney transplantation and were suspected TRAS after transplantation with stenosis under 50% independent on age, who were referred for angiography at a single center between January 2007 and December 2014. Results: During this period, 6,829 kidney transplants were performed at Hospital do Rim, 313 of them had clinical suspicion of TRAS and 54 were those who presented no-significant stenosis. The average age was 35.93 years old, the predominant gender was male and most individuals (94.4%) were submitted to dialysis before transplantation. Transplants, in most cases in this group, occurred from a deceased donor, 66.7%. The time between transplantation and angiography was less than one year in 79.6% of patients and all presented no-significant TRAS. Creatinine levels, Systolic Blood Pressure, Diastolic Blood Pressure and the glomerular filtration rate improved over the long term. The outcomes found were death and renal loss.Conclusion: Age, sex and ethnic group of patients are factors that did not interfere with the frequency of renal artery stenosis. The outcomes showed that in the long term most patients evolve well, and have improved quality of life and kidney function, although there are cases of death and kidney loss.

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Effect of Percutaneous Transluminal Renal Angioplasty on Absolute Split Renal Function in Patients with Renovascular Hypertension. Influence of Age and Other Parameters

Urologia Journal ◽

10.1177/039156039306000106 ◽

1993 ◽

Vol 60 (1) ◽

pp. 27-33

Author(s):

M. Takeda ◽

Y. Katayama ◽

K. Saito ◽

T. Tsutsui ◽

T. Komeyama ◽

...

Keyword(s):

Blood Pressure ◽

Renal Function ◽

Renal Artery ◽

Renal Artery Stenosis ◽

Plasma Renin ◽

Artery Stenosis ◽

Renal Angioplasty ◽

Split Renal Function ◽

Percutaneous Transluminal Renal Angioplasty ◽

Percutaneous Transluminal

Tc99m-dimercaptosuccinic acid renal uptake (DMSA uptake) was examined to assess the changes in split renal function following percutaneous transluminal renal angioplasty (PTRA) in 9 patients with a total of 12 renal artery stenoses and renovascular hypertension (RVH). The results were studied with respect to age, degree of renal artery stenosis, and renal vein renin ratio (RVRR) before PTRA. Although the degree of renal artery stenosis, systolic blood pressure, and peripheral blood plasma renin activity were improved 3 months after PTRA, neither the DMSA uptake of the affected kidneys nor that of the contralateral kidneys improved. Although restenosis occurred during the long follow-up period in one patient, DMSA uptake did not change in parallel with the degree of stenosis or RVRR. The degree of improvement in DMSA uptake, blood pressure, and plasma renin activity after PTRA in patients aged under 70 years was significantly higher than that in patients 70 years or older. Good improvement of renal function was attained in a 4-year-old boy, despite the fact that split renal function prior to PTRA was so poor that nephrectomy had been considered instead of PTRA. These results suggest that several factors before PTRA, such as DMSA uptake, degree of renal artery stenosis, and RVRR, are not absolutely predictive of results after PTRA, and that the effect of PTRA on blood pressure and renal function is greater in younger patients.

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P3564Percutaneous intervention with stent improves blood pressure and renal function in patients with transplanted renal artery stenosis

European Heart Journal ◽

10.1093/eurheartj/ehz745.0427 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

A Galhardo ◽

G Kanhouche ◽

G R S Feitosa ◽

H O Campos ◽

A C B Faccinetto ◽

...

Keyword(s):

Blood Pressure ◽

Renal Function ◽

Renal Artery ◽

Renal Artery Stenosis ◽

Peak Systolic Velocity ◽

Artery Stenosis ◽

Complication Rates ◽

Post Intervention ◽

Refractory Hypertension ◽

Significant Difference

Abstract Background Transplanted renal artery stenosis (TRAS) is the main vascular complication of patients undergoing kidney transplantat, with a reported incidence ranging from 1% to 23%. Clinically important TRAS is associated with refractory hypertension, graft dysfunction and increased peak systolic velocity (PSV) above 200 cm/s. Percutaneous intervention (PI) of TRAS with or without stent is widely accepted as a viable and safe treatment option. Purpose To evaluate blood pressure and renal function in patients with TRAS undergoing PI in the following year. Methods Between January 2007 and December 2014, 310 patients with suspected TRAS underwent consecutive angiography. Of these, 173 presented significant stenosis (>60%) and were submitted to PI. Endpoints were systolic blood pressure (SBP), diastolic blood pressure (DBP), serum creatinine (Scr), number of blood pressure medications and PSV with one month and one year post intervention. Results The mean age was 42.89±15.03 years, 78% of the population were male, 84% received kidneys from decesed donors, 94% having received a stent. The angiographic success and complication rates were 98% and 8,4% respectively. 98.7% were on blood pressure medications with 2.13±1.05 drugs/patient. Pre-intervention values of SBP, DBP and Scr were 152.8±25.28 mmHg, 92.67±16.43 mmHg and 3.04±2.75 mg/dL, respectively. After 1 month, there was a significant reduction in SBP (138.34±19.71; p<0.0001), DBP (82.52±12.2; p<0.0001) and Scr (2.13±1.39 mg/dl, p<0.0001). Following 01 year, SBP, DBP and Scr were 133.55±17.51, p<0.0001; 83.51±11.23, p<0.0001 (Figure); and Scr 1.94±1.09 mg/dL, p<0.0001 respectively. There was a significant reduction in post-intervention PSV when compared to baseline results (422.2±148.8 vs. 237.1±104.6 m/s, p<0.0001). There was no significant difference in the number of blood pressure medications pre and post intervention (2.13 vs 2.05; p=0.68). Evolution of Blood Pressure Conclusion PI with stent of TRAS was effective in improving blood pressure and renal function levels on month 1 and on year 1 with a low rate of complications.

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