Atherosclerotic Nephropathy in Renal Artery Stenosis -
from Randomized Trials to the Individualized Treatment
Okša A.1, Dzúrik R.1, Demeš M.2
1Ústav preventívnej a klinickej medicíny, Bratislava, Slovenská republika, riaditeľ doc. MUDr. Š. Nyulassy, DrSc. 2Interná klinika SPAM a FNsP ak. L. Dérera, Bratislava, Slovenská republika, vedúci doc. MUDr. Š. Hrušovský, CSc. |
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Summary:
Randomized trials in hypertensive patients with atherosclerotic renal artery stenosis (ARAS)
mostly did not reveal any significant difference between antihypertensive treatment and revascularization
(by angioplasty or bypass surgery) in their effects on blood pressure or glomerular filtration
rate. This unexpected conclusion reflects a fact that in addition to potentially reversible
ischemia, some other factors which are not eliminated by technically successful revascularization
take part in the decrease of renal function in ARAS, including cholesterol microemboli from atherosclerotic
plaques, secondary focal segmental glomerulosclerosis and hypertensive nephroangiosclerosis.
Moreover, these changes have been also found in the contralateral kidney without any
stenosis. Scintigraphic studies confirmed that the individual kidney function was not related to
the presence of ARAS, i.e., the glomerular filtration rate in the stenotic kidney was often equal to,
or paradoxically even better than that in the kidney with normal renal artery. This has obviously
important consequences for the indication of revascularization which should be based on measurement
of the individual kidney function rather than overall renal function. A conservative treatment
of ARAS should comprise ACE inhibitors or angiotensin II receptor antagonists, statins
and acetylsalicylic acid. The long-term effect of such treatment on the progression of atherosclerotic
nephropathy is now being evaluated in randomized trials.
Key words:
Atherosclerotic/ischemic nephropathy - Renal artery stenosis - Renovascular hypertension
- Angioplasty - Randomized trials
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