Kim P K, Spriggs D W, Rutecki G W, Reaven R E, Blend D, Whittier F C
Department of Internal Medicine, Northeastern Ohio Universities, Affiliated Hospitals at Canton 44708.
AJR Am J Roentgenol. 1989 Dec;153(6):1305-8. doi: 10.2214/ajr.153.6.1305.
Renal angioplasty in patients with bilateral renal artery stenosis or with renal artery stenosis in a solitary functioning kidney has been thought to be relatively contraindicated. We report the results of renal artery angioplasty in 18 patients, 10 with severe bilateral renal artery stenosis and eight with severe renal artery stenosis in a solitary kidney. Twenty-five (89%) of 28 angioplasties were successful, with a mean improvement of the degree of stenosis from 85% to 18% after angioplasty and a restoration of renal blood flow. A significant drop in mean blood pressure at admission of 187/101 mm Hg to 154/87 mm Hg at discharge, 152/86 mm Hg at 3-month, and 146/82 mm Hg at 1-year follow-up was seen. Because of the decrease in blood pressure, 11 of the patients decreased or stopped taking diuretics and 15 decreased or stopped taking antihypertensive medications. Although no significant change in renal function was found by measuring mean serum creatinine levels over time, no patient had an elevated serum creatinine level at follow-up, indicating preservation of renal function. One major complication, cholesterol embolization to the bowel, was seen. Our results suggest that angioplasty is an acceptable treatment of hypertension in patients with bilateral renal artery stenosis or renal artery stenosis in a single kidney.
双侧肾动脉狭窄患者或仅有一个功能肾且伴有肾动脉狭窄的患者进行肾血管成形术一直被认为相对禁忌。我们报告了18例患者的肾动脉血管成形术结果，其中10例为严重双侧肾动脉狭窄，8例为单肾严重肾动脉狭窄。28次血管成形术中25次（89%）成功，血管成形术后狭窄程度平均从85%改善至18%，肾血流恢复。入院时平均血压为187/101 mmHg，出院时降至154/87 mmHg，3个月时为152/86 mmHg，1年随访时为146/82 mmHg，有显著下降。由于血压下降，11例患者减少或停用了利尿剂，15例患者减少或停用了抗高血压药物。虽然随着时间推移测量平均血清肌酐水平未发现肾功能有显著变化，但随访时无患者血清肌酐水平升高，表明肾功能得以保留。出现了1例主要并发症，即肠道胆固醇栓塞。我们的结果表明，血管成形术是双侧肾动脉狭窄或单肾肾动脉狭窄患者高血压的一种可接受的治疗方法。
