Division of Nephrology, Endocrinology, and Vascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan.
Department of Medicine, Katta General Hospital, Shiroishi, Japan.
Am J Hypertens. 2020 Apr 29;33(5):391-401. doi: 10.1093/ajh/hpaa016.
Atherosclerotic renal artery stenosis (ARAS) can cause secondary hypertension, progressive decline in renal function, and cardiac complications. Recent randomized controlled trials including the Cardiovascular Outcomes in Renal Atherosclerotic Lesions study have not reported the benefit of renal artery stenting compared with medical therapy alone to improve renal function or reduce cardiovascular and renal events in the enrolled patients with ARAS. However, observational evidence indicating the benefits of angioplasty in the selected high-risk patients with ARAS has been increasing. Thus, the timely correction of stenosis through angioplasty may have a beneficial effect in selected patients. However, optimal patient selection for angioplasty has been debated and can be challenging at times. Clinicians must identify the responsive patients who would benefit from angioplasty through risk stratification and the prediction of outcomes. Efforts have been made for the determination of predictors that can identify the subgroups of patients who would benefit from angioplasty. Lower age, more severe stenosis, preserved renal perfusion, and absence of diabetes or generalized atherosclerosis have been reported as the predictors for the improvement of hypertension after angioplasty. Global renal ischemia, rapidly declining renal function over 6-12 months, progressive shrinkage of the affected kidney, lower resistive index, and lower levels of albuminuria have been reported as predictors of improved or preserved renal function after angioplasty. This review discusses the identification of ARAS patients who will potentially respond well to angioplasty.
动脉粥样硬化性肾动脉狭窄（ARAS）可导致继发性高血压、肾功能进行性下降和心脏并发症。最近的随机对照试验，包括心血管结果在肾动脉粥样硬化病变研究中，并未报告肾动脉支架置入术与单纯药物治疗相比，在改善肾功能或减少 ARAS 患者心血管和肾脏事件方面的获益。然而，越来越多的观察性证据表明血管成形术对选择的高危 ARAS 患者有益。因此，通过血管成形术及时纠正狭窄可能对选择的患者有益。然而，血管成形术的最佳患者选择一直存在争议，有时也具有挑战性。临床医生必须通过风险分层和预测结果来识别那些将从血管成形术获益的有反应性患者。已经努力确定可以识别将从血管成形术获益的患者亚组的预测因子。有研究报道，年龄较低、狭窄更严重、保留肾灌注、无糖尿病或全身性动脉粥样硬化是血管成形术后高血压改善的预测因子。全球肾缺血、6-12 个月内肾功能迅速下降、受影响的肾脏进行性缩小、阻力指数降低和蛋白尿水平降低被报道为血管成形术后肾功能改善或保留的预测因子。本文综述讨论了识别可能对血管成形术反应良好的 ARAS 患者的方法。
