Martin L G, Casarella W J, Gaylord G M
Department of Radiology, Emory University Hospital, Atlanta, GA 30322.
AJR Am J Roentgenol. 1988 Apr;150(4):839-44. doi: 10.2214/ajr.150.4.839.
Percutaneous angioplasty of the renal artery was performed in 79 patients who had stable or climbing serum creatinine levels greater than 1.7 mg/dl and hemodynamically significant stenosis of the renal artery. Patients who had nonrenal causes of azotemia, nephropathy caused by iodinated contrast material, or serum creatinine levels that were declining while the patients were receiving medical therapy before angioplasty were excluded from the study. Angioplasty resulted in a significant (greater than 20%) decline in the level of serum creatinine (average, 2.7 mg/dl before to 1.7 mg/dl after) in 43% of these patients during an average follow-up period of 16 months. A significant decrease in the level of serum creatinine was seen in 61% of patients with bilateral stenosis, 38% of patients with unilateral stenosis with absent contralateral renal blood flow, and 38% of patients with unilateral stenosis and normal contralateral renal blood flow. Recapture of lost nephron function was least successful in patients whose levels of serum creatinine were greater than 4.0 mg/dl (14%); this included one (11%) of nine patients who were already on hemodialysis. We conclude that angioplasty of the renal artery can play a major role in the treatment of patients who have mild azotemia and bilateral stenosis of the renal artery. It is less successful in treatment of patients who have severe azotemia and those who have unilateral disease.
对79例血清肌酐水平稳定或持续升高且大于1.7mg/dl、肾动脉存在血流动力学显著狭窄的患者进行了经皮肾动脉血管成形术。排除有非肾性氮质血症病因、碘造影剂所致肾病或在血管成形术前接受药物治疗时血清肌酐水平下降的患者。在平均16个月的随访期内，43%的此类患者血管成形术后血清肌酐水平显著下降（超过20%）（平均从术前的2.7mg/dl降至术后的1.7mg/dl）。双侧狭窄患者中61%、单侧狭窄且对侧肾血流缺失患者中38%以及单侧狭窄且对侧肾血流正常患者中38%的血清肌酐水平显著下降。血清肌酐水平大于4.0mg/dl的患者恢复丢失的肾单位功能最不成功（14%）；这包括9例已接受血液透析患者中的1例（11%）。我们得出结论，肾动脉血管成形术在治疗轻度氮质血症和双侧肾动脉狭窄患者中可发挥主要作用。在治疗重度氮质血症患者和单侧病变患者中效果较差。
