Department of Medicine, Division of Nephrology, Hypertension and Endocrinology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan.
Hypertens Res. 2010 Nov;33(11):1206-10. doi: 10.1038/hr.2010.152. Epub 2010 Aug 12.
Angioplasty with insertion of an endoprosthesis is an effective treatment for atheromatous renal artery stenosis (ARAS). However, this procedure may cause deterioration in renal function, and it is imperative to define the cases that could benefit from angioplasty. From 456 suspected renovascular hypertension cases, 33 were given a diagnosis of unilateral ARAS on renal arteriography. These unilateral ARAS cases were treated by angioplasty, and their baseline variables were evaluated with respect to the improvement achieved in post-angioplastic renal function of the treated side as measured by renal scintigram. The estimated glomerular filtration rate (eGFR) was the only variable that was significantly different between cases that showed improvement in renal function and those that did not. Cases that showed improvement in renal function had lower pre-angioplasty eGFR compared with cases that did not show improvement (59±24 ml min⁻¹ 1.73 m⁻² vs. 76±12 ml min⁻¹ 1.73 m⁻², P=0.04), and cases showing improvement were generally at later stages of chronic kidney disease (CKD). Most patients without improvement, who were generally at earlier stages of CKD, had a systemic blood pressure reduction after angioplasty. The present findings indicate that the baseline CKD stage could be used to predict the outcome of angioplasty for ARAS.
经皮腔内血管成形术联合血管内支架置入术治疗动脉粥样硬化性肾动脉狭窄(ARAS)效果显著。然而,该术式可能导致肾功能恶化,因此,明确哪些患者能够从该术式中获益至关重要。对 456 例疑似肾血管性高血压患者进行肾动脉造影检查,结果提示 33 例患者为单侧 ARAS。对这 33 例单侧 ARAS 患者进行了经皮腔内血管成形术治疗,并根据肾闪烁扫描评估治疗侧肾功能改善情况评估患者的基础变量。结果显示,只有估算肾小球滤过率(eGFR)在肾功能改善组和未改善组间存在显著差异。与未改善组相比,肾功能改善组患者的术前 eGFR 更低(59±24ml/min·1.73m² vs. 76±12ml/min·1.73m²,P=0.04),且肾功能改善组患者的慢性肾脏病(CKD)分期通常更晚。大多数未改善患者的 CKD 分期通常更早,术后血压下降。由此可见,基线 CKD 分期可用于预测 ARAS 经皮腔内血管成形术的治疗效果。