Sugimoto Hisashi, Yamamoto Shinya, Yanagita Motoko
Department of Nephrology, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
Institute for the Advanced Study of Human Biology (WPI-ASHBi), Kyoto University, Kyoto, Japan.
Nephron. 2025;149(3):160-165. doi: 10.1159/000542416. Epub 2024 Nov 1.
Previous randomized controlled trials have not demonstrated the benefits of renal artery stenting with respect to kidney function. However, these trials did not focus on patients with severely impaired kidney function caused by severe bilateral stenosis. Therefore, the efficacy of stenting in such patients remains unclear.
We report 4 cases of successful percutaneous transluminal renal angioplasty (PTRA) with severely impaired kidney function with rapid decline caused by bilateral atherosclerotic stenosis. The catheterization before irreversible parenchymal damages was useful in improving kidney function dramatically in these cases of severe bilateral renal artery stenosis. Furthermore, we examined the clinical characteristics of the 4 cases to identify the potential predictors of PTRA effectiveness. Notably, bilateral renal artery >90% stenosis, elevated plasma renin activity, estimated glomerular filtration rate <15 mL/min/1.73 m2 with an accelerated decline within 6 months before PTRA (>50 mL/min/1.73 m2/6 months), and resistance index (RI) <0.7 were identified as common findings.
PTRA should be considered a treatment strategy for patients with these features to preserve kidney function and avoid dialysis therapy.
Previous randomized controlled trials have not demonstrated the benefits of renal artery stenting with respect to kidney function. However, these trials did not focus on patients with severely impaired kidney function caused by severe bilateral stenosis. Therefore, the efficacy of stenting in such patients remains unclear.
We report 4 cases of successful percutaneous transluminal renal angioplasty (PTRA) with severely impaired kidney function with rapid decline caused by bilateral atherosclerotic stenosis. The catheterization before irreversible parenchymal damages was useful in improving kidney function dramatically in these cases of severe bilateral renal artery stenosis. Furthermore, we examined the clinical characteristics of the 4 cases to identify the potential predictors of PTRA effectiveness. Notably, bilateral renal artery >90% stenosis, elevated plasma renin activity, estimated glomerular filtration rate <15 mL/min/1.73 m2 with an accelerated decline within 6 months before PTRA (>50 mL/min/1.73 m2/6 months), and resistance index (RI) <0.7 were identified as common findings.
PTRA should be considered a treatment strategy for patients with these features to preserve kidney function and avoid dialysis therapy.
既往随机对照试验尚未证明肾动脉支架置入术对肾功能有益。然而，这些试验并未聚焦于由严重双侧狭窄导致肾功能严重受损的患者。因此，支架置入术对此类患者的疗效仍不明确。
我们报告了4例因双侧动脉粥样硬化狭窄导致肾功能严重受损且迅速下降的患者成功接受经皮腔内肾血管成形术（PTRA）的病例。在出现不可逆的实质损害之前进行导管插入术，对于显著改善这些严重双侧肾动脉狭窄病例的肾功能很有用。此外，我们检查了这4例患者的临床特征，以确定PTRA有效性的潜在预测因素。值得注意的是，双侧肾动脉狭窄>90%、血浆肾素活性升高、估计肾小球滤过率<15 mL/（min·1.73 m²）且在PTRA前6个月内加速下降（>50 mL/（min·1.73 m²）/6个月）以及阻力指数（RI）<0.7被确定为常见表现。
对于具有这些特征的患者，应考虑将PTRA作为一种治疗策略，以保护肾功能并避免透析治疗。
既往随机对照试验尚未证明肾动脉支架置入术对肾功能有益。然而，这些试验并未聚焦于由严重双侧狭窄导致肾功能严重受损的患者。因此，支架置入术对此类患者的疗效仍不明确。
我们报告了4例因双侧动脉粥样硬化狭窄导致肾功能严重受损且迅速下降的患者成功接受经皮腔内肾血管成形术（PTRA）的病例。在出现不可逆的实质损害之前进行导管插入术，对于显著改善这些严重双侧肾动脉狭窄病例的肾功能很有用。此外，我们检查了这4例患者的临床特征，以确定PTRA有效性的潜在预测因素。值得注意的是，双侧肾动脉狭窄>90%、血浆肾素活性升高、估计肾小球滤过率<15 mL/（min·1.73 m²）且在PTRA前6个月内加速下降（>50 mL/（min·1.73 m²）/6个月）以及阻力指数（RI）<0.7被确定为常见表现。
对于具有这些特征的患者，应考虑将PTRA作为一种治疗策略，以保护肾功能并避免透析治疗。
