Renal Artery Stenosis (cont.)
Which patients can benefit from surgical procedures for renal artery stenosis?
In patients with renal failure due to bilateral renal
artery stenosis (narrowing on both kidneys), angioplasty procedures for both
renal arteries may improve or stabilize kidney function. Similarly, in
hypertensive patients with unilateral (one-sided) renal artery stenosis,
angioplasty procedures of the involved renal artery may cure or improve the high blood pressure. Patients with
milder degrees of stenosis (less than a 75% reduction in the width of the renal
artery lumen) usually do not benefit from angioplasty. These patients need to be
followed by sequential imaging procedures to detect further narrowing
(progression) to the point of treatable stenosis. At that point, angioplasty
procedures can be done with the hope of a favorable response.
Some studies have suggested that patients with a very
high degree of renal vascular resistance (which reflects permanent damage to the
kidneys), even with a 75% or more stenosis of the renal artery, often have a
poor response to the angioplasty procedures. (The tension of the blood vessels
to the kidney, called renal vascular resistance, is measured by Doppler
ultrasonography. A so-called resistive index over 0.8 is considered very high).
In these patients, angioplasty is usually not done and the high blood pressure
or renal failure is managed only by the customary therapeutic measures for these problems as
described previously.
Renal Artery Stenosis At A Glance
- Elevated blood pressure (hypertension) is common and is generally simply
treated with medications.
- Likewise, various other methods are used to treat the
large majority of patients with kidney failure.
- There is a small subgroup of
patients with high blood pressure or renal failure caused by renal artery
stenosis.
- Some of these patients may respond favorably to
dilating the narrowed
artery, using the technique of angioplasty.
- The patients that can benefit from
angioplasty have a severe stenosis (75 % or greater narrowing) of the renal
artery and do not have a very high renal vascular resistance.
References:
eMedicine, "Renal Artery Stenosis."
eMedicine, "Renal Artery Stenosis/Renovascular Hypertension."
Previous contributing author and editor: Dwight Makoff, M.D.
and Leslie
J. Schoenfield, M.D., Ph.D.
Last Editorial Review: 10/7/2008
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