a Division of Hypertension and Nephrology , National Cerebral and Cardiovascular Center , Osaka , Japan and.
b Department of Radiology , National Cerebral and Cardiovascular Center , Osaka , Japan.
Clin Exp Hypertens. 2015;37(7):526-30. doi: 10.3109/10641963.2015.1013125. Epub 2015 Apr 28.
To identify candidates for PTRA in terms of the preservation of renal function, we herein evaluated factors that caused worsening renal function (WRF) after PTRA.
We evaluated 92 patients with atherosclerotic renal artery stenosis (mean age 70.7 ± 8.4 years). WRF was defined as a ≥0.3 mg/dL increase in creatinine levels after PTRA compared to before PTRA.
A total of 92 patients exhibited non-WRF 83 (90.2%), WRF 9 (9.8%). Significant differences were observed in serum creatinine levels between two groups both before (non-WRF 1.34 ± 0.49 versus WRF 1.70 ± 0.68 mg/dL, p = 0.0462) and after PTRA (non-WRF 1.31 ± 0.43 versus WRF 2.42 ± 1.12 mg/dL, p < 0.0001). Patients with WRF had higher comorbidity rate of diabetes mellitus (DM) (non-WRF 31.3% versus WRF 66.7%, p = 0.0345) and proteinuria (non-WRF 27.7% versus WRF 66.7%, p = 0.0169), and had higher systolic blood pressure (non-WRF 143.6 ± 18.7 versus WRF 157.1 ± 19.9 mmHg, p = 0.0436), higher plasma B-type natriuretic peptide (BNP) levels, and larger left atrial and left ventricular end-diastolic dimensions before PTRA. Patients with WRF had a higher rate of taking diuretics (non-WRF 27.7% versus WRF 66.7%, p = 0.0169) after PTRA. Multiple logistic regression analysis revealed that comorbidity of DM was an independent related factor for WRF (comorbidity of DM, yes: OR 31.0, 95% CI 2.44-1024.62, p = 0.0055).
Comorbidity of DM, coexisting of proteinuria, high creatinine level, high blood pressure, high BNP levels, and large left atrial and ventricular dimensions were related to WRF after PTRA in patients with atherosclerotic renal artery stenosis.
为了确定经皮腔内血管成形术（PTRA）后肾功能恶化（WRF）的候选者，我们评估了 PTRA 后导致肾功能恶化的因素。
我们评估了 92 例粥样硬化性肾动脉狭窄患者（平均年龄 70.7±8.4 岁）。WRF 定义为与 PTRA 前相比，PTRA 后肌酐水平升高≥0.3mg/dL。
92 例患者中，83 例（90.2%）为非 WRF，9 例（9.8%）为 WRF。两组患者的血清肌酐水平在 PTRA 前（非 WRF 为 1.34±0.49 与 WRF 为 1.70±0.68mg/dL，p=0.0462）和 PTRA 后（非 WRF 为 1.31±0.43 与 WRF 为 2.42±1.12mg/dL，p<0.0001）均有显著差异。WRF 患者的糖尿病（DM）合并症发生率更高（非 WRF 为 31.3%，WRF 为 66.7%，p=0.0345）和蛋白尿（非 WRF 为 27.7%，WRF 为 66.7%，p=0.0169），且收缩压更高（非 WRF 为 143.6±18.7mmHg，WRF 为 157.1±19.9mmHg，p=0.0436），血浆 B 型利钠肽（BNP）水平更高，左心房和左心室舒张末期内径更大。WRF 患者 PTRA 后利尿剂使用率更高（非 WRF 为 27.7%，WRF 为 66.7%，p=0.0169）。多因素逻辑回归分析显示，DM 合并症是 WRF 的独立相关因素（DM 合并症，是：OR 31.0，95%CI 2.44-1024.62，p=0.0055）。
在粥样硬化性肾动脉狭窄患者中，DM 合并症、蛋白尿共存、肌酐水平升高、血压升高、BNP 水平升高以及左心房和心室尺寸增大与 PTRA 后 WRF 相关。
