Options for therapy of ischemic nephropathy: role of angioplasty and surgery.

The development of chronic renal failure from progressive atherosclerotic renal arterial occlusive disease, termed "ischemic nephropathy," is an important clinical problem in older patients with generalized atherosclerosis obliterans. Studies on the natural history of atherosclerotic renal artery disease have made it possible to identify those patients in whom this disease poses a significant threat to overall renal function. Several factors must be considered in evaluating the renal functional benefit of intervention to relieve arterial obstruction. These include the severity and extent of renal artery obstruction, the level of renal function, renal histopathologic information, and the general medical condition of the patient. Intervention to restore normal renal arterial blood flow is indicated in selected patients to prevent deterioration of renal function that may culminate in the need for dialytic replacement therapy. Percutaneous transluminal angioplasty is the treatment of choice for patients with non-ostial atherosclerotic lesions. Most reports in the literature indicate that surgical revascularization provides more effective long-term therapy for patients with ostial atherosclerotic lesions.