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Effects of percutaneous angioplasty on kidney function and blood pressure in patients with atherosclerotic renal artery stenosis

Kidney Research and Clinical Practice 2019년 38권 3호 p.336 ~ 346
김수현 ( Kim Su-Hyun ) - Sungkyunkwan University School of Medicine Samsung Medical Center Department of Medicine

 ( Kim Mi-Jeoung ) - Sungkyunkwan University School of Medicine Samsung Medical Center Department of Medicine
 ( Jeon Jeun-Seok ) - Sungkyunkwan University School of Medicine Samsung Medical Center Department of Medicine
 ( Jang Hye-Ryoun ) - Sungkyunkwan University School of Medicine Samsung Medical Center Department of Medicine
 ( Park Kwang-Bo ) - Sungkyunkwan University School of Medicine Samsung Medical Center Department of Radiology
 ( Huh Woo-Seong ) - Sungkyunkwan University School of Medicine Samsung Medical Center Department of Medicine
 ( Do Young-Soo ) - Sungkyunkwan University School of Medicine Samsung Medical Center Department of Radiology
 ( Kim Yoon-Goo ) - Sungkyunkwan University School of Medicine Samsung Medical Center Department of Medicine
 ( Kim Dae-Joong ) - Sungkyunkwan University School of Medicine Samsung Medical Center Department of Medicine
 ( Oh Ha-Young ) - Sungkyunkwan University School of Medicine Samsung Medical Center Department of Medicine
 ( Lee Jung-Eun ) - Sungkyunkwan University School of Medicine Samsung Medical Center Department of Medicine

Abstract


Background: Previous randomized controlled trials of revascularization for atherosclerotic renal artery stenosis (ARAS) were not successful. We investigated the effects of percutaneous transluminal angioplasty with stent insertion (PTA/S) on kidney function and blood pressure (BP) control in patients with ARAS.

Methods: From 2000 to 2017, 47 subjects who underwent PTA/S for ARAS were identified. A high-risk group was defined, composed of patients having one or more of the following clinical presentations: pulmonary edema, refractory hypertension, and rapid deterioration of kidney function. Subjects who met the criteria of ‘kidney function improvement’ or ‘hypertension improvement’ after PTA/S were classified as responders.

Results: Twenty-one (44.7%) subjects were classified into the high-risk group. Two subjects (8.0%) in the low-risk group (n = 25) and 5 subjects (27.8%) in the high-risk group (n = 18) showed improvement in kidney function after PTA/S (P = 0.110). In patients with rapid decline of kidney function, estimated glomerular filtration rate improved from 28 (interquartile range [IQR], 10?45) mL/min/1.73 m2 to 41 (IQR, 16?67) mL/min/1.73 m2 at 4 months after PTA/S, although the difference was not significant (P = 0.084). Regarding BP control, 9 (36.0%) and 14 (77.8%) subjects showed improvement after PTA/S in the low- (n = 25) and high-risk (n = 18) groups, respectively (P = 0.007). In patients with refractory hypertension, the systolic BP dropped from 157 (IQR, 150?164) mmHg to 140 (IQR, 131?148) mmHg at 4 months after PTA/S (P = 0.005). Twenty-five subjects were defined as responders and comprised a significant proportion of the high-risk group (P = 0.004).

Conclusion: PTA/S might improve BP control and kidney function in patients with ARAS presenting with high-risk clinical features. The optimal application of PTA/S should be based on individual assessment of the clinical significance of renal artery stenosis.

키워드

Angioplasty; Blood pressure; Glomerular filtration rate; Renal artery stenosis
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