Abboud Jaber, Römer Albrecht, Kasper Wolfgang, Kaess Bernhard M, Haack Stefan, Mettang Thomas, Vonend Oliver, Ehrlich Joachim R
Div. of Cardiology, St. Josefs-Hospital, Beethovenstr. 20, 65189 Wiesbaden, Germany.
Nierenzentrum, von Leyden Strasse, 65189 Wiesbaden, Germany.
Int J Cardiol Heart Vasc. 2020 Jan 30;27:100475. doi: 10.1016/j.ijcha.2020.100475. eCollection 2020 Apr.
Renal artery stenosis (RAS) can lead to hypertension and renal failure. Nevertheless, its treatment by percutaneous transluminal renal angioplasty (PTRA) remains controversial. It is unknown, whether patients with global kidney ischemia (GKI), that means patients with bilateral RAS or RAS with a single functioning kidney, may benefit from PTRA or not.
We retrospectively analyzed 93 patients with RAS (25 bilateral or single functioning kidney) undergoing PTRA. Patients had refractory hypertension (≥3 medications). Blood pressure, antihypertensive drugs and serum-creatinine were compared pre-/post-intervention and at 1 year's follow-up.
At 1 year after PTRA of patients with GKI, systolic and diastolic blood pressure were significantly reduced compared to patients with unilateral PTRA (systolic: -19.1 ± 10.5 [bilateral] vs. -11.4 ± 12.1 mmHg [unilateral], P < 0.01; diastolic: -10.1 ± 6.8 mmHg vs. -6.3 ± 6.6 mmHg, P < 0.05). The number of antihypertensive drugs was reduced by -0.8 ± 3.0 at 1 year in patients with GKI, while it increased by +0.1 ± 3.5 in the unilateral RAS group (P < 0.001). Furthermore, post-interventional serum-creatinine decreased by -34.6 ± 31.4 μmol/I after of patients with GKI (P < 0.001 vs. baseline). In patients with unilateral PTRA, a non-significant increase in serum-creatinine was observed (+8.3 ± 2 μmol/l).
PTRA in patients with GKI led to improved blood pressure and renal function. A large, well-designed, randomized clinical trial targeting this population is still needed. The benefit of PTRA should be measured with the risks in each patient individually.
肾动脉狭窄（RAS）可导致高血压和肾衰竭。然而，经皮腔内肾血管成形术（PTRA）对其治疗仍存在争议。目前尚不清楚，患有全肾缺血（GKI）的患者，即双侧RAS或伴有单个功能肾的RAS患者，是否能从PTRA中获益。
我们回顾性分析了93例行PTRA的RAS患者（25例双侧或单个功能肾）。患者患有顽固性高血压（使用≥3种药物）。对比干预前后及随访1年时的血压、降压药物和血清肌酐水平。
GKI患者PTRA术后1年，收缩压和舒张压与单侧PTRA患者相比显著降低（收缩压：-19.1±10.5[双侧] vs. -11.4±12.1mmHg[单侧]，P<0.01；舒张压：-10.1±6.8mmHg vs. -6.3±6.6mmHg，P<0.05）。GKI患者术后1年降压药物数量减少-0.8±3.0，而单侧RAS组增加+0.1±3.5（P<0.001）。此外，GKI患者干预后血清肌酐下降-34.6±31.4μmol/L（与基线相比P<0.001）。单侧PTRA患者血清肌酐有不显著升高（+8.3±2μmol/L）。
GKI患者行PTRA可改善血压和肾功能。针对该人群仍需要进行一项大型、设计良好的随机临床试验。PTRA的益处应根据每位患者的风险单独衡量。
