Cianci Rosario, Gigante Antonietta, Polidori Lelio, Di Donato Domenico, Martina Paola, Barbano Biagio, Renzulli Roberta, Zaccaria Alvaro, Fuiano Giorgio
Department of Nephrology, University of Rome La Sapienza, Rome, Italy.
Angiology. 2009 Aug-Sep;60(4):496-503. doi: 10.1177/0003319708322172. Epub 2008 Sep 15.
Renal artery stenosis (RAS) caused by atherosclerotic changes of the renal arteries has become a concern as a cause of end-stage renal failure. Percutaneous balloon angioplasty with or without endovascular stenting is an increasingly accepted procedure at the expense of classical approaches such as aortorenal bypass and other types of surgery. Renal percutaneous transluminal angioplasty and stenting (RPTAS) represent the first therapeutic choice; however, there is doubt regarding the satisfactory long-term outcome for primary RPTAS. Currently, there is no clear evidence whether or not RPTAS prevents further progressive renal function decline because comparisons between interventional randomized studies and medical therapy are still lacking. Despite the fact that the use of angiotensin-converting enzyme inhibitors (ACEIs) may be a potential cause of acute renal failure, clinical data suggest that ACEI therapy is associated with better survival in patient with RAS. In our case, the use of ACEIs has been fundamental for the indirect evaluation of restenosis degree and RPTAS.
由肾动脉粥样硬化改变引起的肾动脉狭窄（RAS）已成为终末期肾衰竭的一个病因，备受关注。无论有无血管内支架置入，经皮球囊血管成形术作为一种治疗手段，相比诸如主动脉肾动脉搭桥术和其他类型的外科手术等传统方法，越来越被广泛接受。肾经皮腔内血管成形术和支架置入术（RPTAS）是首选治疗方法；然而，对于原发性RPTAS能否获得令人满意的长期疗效仍存在疑问。目前，尚无明确证据表明RPTAS能否预防肾功能进一步恶化，因为介入性随机研究与药物治疗之间的比较仍然缺乏。尽管使用血管紧张素转换酶抑制剂（ACEIs）可能是急性肾衰竭的一个潜在病因，但临床数据表明，ACEI治疗与RAS患者更好的生存率相关。在我们的病例中，ACEIs的使用对于间接评估再狭窄程度和RPTAS至关重要。
