Division of Nephrology and Hypertension, Mayo Clinic, Rochester MN.
Division of Nephrology and Hypertension, Mayo Clinic, Rochester MN.
Am J Kidney Dis. 2018 May;71(5):748-753. doi: 10.1053/j.ajkd.2017.11.014. Epub 2018 Feb 9.
Current trends in managing atherosclerotic renal artery stenosis favor medical therapy, on account of negative results from prospective trials of revascularization, such as CORAL and ASTRAL. One result of this trend has been encountering occasional patients with progressive disease, sometimes leading to total arterial occlusion. We illustrate a case of accelerated hypertension with complete renal artery occlusion in which the patient recovered function after surgical bypass and we review the clinical approach used and the advanced imaging modalities available to us. A high index of suspicion and careful radiologic imaging play important roles in selecting patients who may have residual function and may benefit from revascularization. This case illustrates an example whereby restoring renal artery perfusion for carefully selected patients can be life changing, with recovery of kidney function and improved blood pressure, pill burden, and overall quality of life.
目前，动脉粥样硬化性肾动脉狭窄的治疗趋势倾向于采用药物治疗，这是因为血管重建的前瞻性试验（如 CORAL 和 ASTRAL）得出了负面结果。这一趋势的结果之一是偶尔会遇到进展性疾病的患者，有时会导致完全动脉闭塞。我们举例说明了一例加速性高血压导致完全性肾动脉闭塞的病例，患者在接受旁路手术后恢复了肾功能，我们还回顾了我们使用的临床方法和现有的先进影像学手段。高度怀疑和仔细的影像学检查在选择可能有残留功能并可能受益于血管重建的患者方面发挥着重要作用。这个病例说明了一个例子，即为精心挑选的患者恢复肾动脉灌注可以改变生活，恢复肾功能，降低血压，减少药物负担，提高整体生活质量。
