Cardiac structure and function after revascularization versus medical therapy for renal artery stenosis: the ASTRAL heart echocardiographic sub-study

Green, Darren; Vassallo, Diana; Handley, Kelly; Ives, Natalie; Wheatley, Keith; Chrysochou, Constantina; Hegarty, Janet; Wright, Julian; Moss, Jon; Patel, Rajan K.; Deighan, Chris; Webster, J; Rowe, P. A.; Carr, Sue; Cross, Jenny; O’Driscoll, Jamie M; Sharma, Raj; Mark, Patrick B.; Kalra, Philip A.

doi:10.1186/s12882-019-1406-y

Cited by 4 publications

(1 citation statement)

References 35 publications

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“…[102][103][104][105] However, 2 major prospective randomized clinical trials, the Angioplasty and Stenting for Renal Artery Lesions (ASTRAL, 806 patients 53 ) and the Cardiovascular Outcomes in Renal Atherosclerotic Lesions (CORAL, 947 patients 106 ), clearly demonstrated that renal angioplasty and stenting did not confer a significant benefit for the prevention of clinical events when added to comprehensive medical therapy. Although a significant proportion of patients included had only modest stenoses, 107 the data revealed added substantial risks by the intervention with limited evidence of clinical benefit in terms of hypertension or recovery of renal function.…”

Section: Revascularization Strategiesmentioning

confidence: 97%

Kidney Intrinsic Mechanisms as Novel Targets in Renovascular Hypertension

Eirin,

Chade,

Lerman

2024

Hypertension

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Almost a hundred years have passed since obstruction of the renal artery has been recognized to raise blood pressure. By now chronic renovascular disease (RVD) due to renal artery stenosis is recognized as a major source of renovascular hypertension and renal disease. In some patients, RVD unaccompanied by noteworthy renal dysfunction or blood pressure elevation may be incidentally identified during peripheral angiography. Nevertheless, in others, RVD might present as a progressive disease associated with diffuse atherosclerosis, leading to loss of renal function, renovascular hypertension, hemodynamic compromise, and a magnified risk for cardiovascular morbidity and mortality. Atherosclerotic RVD leads to renal atrophy, inflammation, and hypoxia but represents a potentially treatable cause of chronic renal failure because until severe fibrosis sets in the ischemic kidney, it retains a robust potential for vascular and tubular regeneration. This remarkable recovery capacity of the kidney begs for early diagnosis and treatment. However, accumulating evidence from both animal studies and randomized clinical trials has convincingly established the inadequate efficacy of renal artery revascularization to fully restore renal function or blood pressure control and has illuminated the potential of therapies targeted to the ischemic renal parenchyma to instigate renal regeneration. Some of the injurious mechanisms identified as potential therapeutic targets included oxidative stress, microvascular disease, inflammation, mitochondrial injury, and cellular senescence. This review recapitulates the intrinsic mechanisms that orchestrate renal damage and recovery in RVD and can be harnessed to introduce remedial opportunities.

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Section: Revascularization Strategiesmentioning

confidence: 97%

Kidney Intrinsic Mechanisms as Novel Targets in Renovascular Hypertension

Eirin,

Chade,

Lerman

2024

Hypertension

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Relationship Between Gene Polymorphism of Methylenetetrahydrofolate Reductase C677T and Left Ventricular Hypertrophy in Chinese Patients with Chronic Kidney Disease

Lin

Xue

et al. 2021

Laboratory Medicine

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Objective This study aimed to investigate the relationship between the gene polymorphism of methylenetetrahydrofolate reductase (MTHFR) C677T and left ventricular hypertrophy (LVH) in patients with chronic kidney disease (CKD). Methods A total of 763 Chinese patients with CKD undergoing genetic testing were included in the study. The association between the gene polymorphism of MTHFR C677T and echocardiographic parameters was analyzed through univariate and multivariate analyses. Results We found a remarkably positive association between MTHFR C677T gene polymorphism and LVH indexes, including interventricular septal thickness (F = 3.8; P = .022), left ventricular posterior wall thickness (F = 3.0; P = .052), left ventricular mass (F = 3.9; P = .022), and left ventricular mass index (F = 2.6; P = .075). After adjusting for the potential confounders linking the polymorphism,we found that the positive association between the polymorphism and LVH indexes still existed in patients with CKD in some multiple linear regression models (P <.05). Conclusion MTHFR C677T gene polymorphism may be a genetic susceptibility marker for the development of LVH in patients with CKD.

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Atherosclerotic renovascular disease: a clinical practice document by the European Renal Best Practice (ERBP) board of the European Renal Association (ERA) and the Working Group Hypertension and the Kidney of the European Society of Hypertension (ESH)

Sarafidis

Theodorakopoulou

Ortíz

et al. 2023

Nephrology Dialysis Transplantation

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Atherosclerotic renovascular disease (ARVD) is the most common type of renal artery stenosis. It represents a common health clinical problem with clinical presentations relevant to many medical specialties and carries high risk for future cardiovascular and renal events, as well as overall mortality. The available evidence regarding the management of ARVD is conflicting. Randomized controlled trials failed to demonstrate superiority of percutaneous transluminal renal artery angioplasty (PTRA) with or without stenting in addition to standard medical therapy compared with medical therapy alone in lowering blood pressure levels or preventing adverse renal and cardiovascular outcomes in patients with ARVD, but they carried several limitations and met important criticism. Observational studies showed that PTRA is associated with future cardiorenal benefits in patients presenting with high-risk ARVD phenotypes (i.e. flash pulmonary oedema, resistant hypertension, or rapid loss of kidney function). This clinical practice document prepared by experts from the European Renal Best Practice (ERBP) board of the European Renal Association (ERA) and from the Working Group on Hypertension and the Kidney of the European Society of Hypertension (ESH) summarizes current knowledge in epidemiology, pathophysiology and diagnostic assessment of ARVD and presents, following a systematic literature review, key evidence relevant to treatment, with an aim to support clinicians in decision-making and everyday management of patients with this condition.

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Cardiac structure and function after revascularization versus medical therapy for renal artery stenosis: the ASTRAL heart echocardiographic sub-study

Cited by 4 publications

References 35 publications

Kidney Intrinsic Mechanisms as Novel Targets in Renovascular Hypertension

Kidney Intrinsic Mechanisms as Novel Targets in Renovascular Hypertension

Relationship Between Gene Polymorphism of Methylenetetrahydrofolate Reductase C677T and Left Ventricular Hypertrophy in Chinese Patients with Chronic Kidney Disease

Atherosclerotic renovascular disease: a clinical practice document by the European Renal Best Practice (ERBP) board of the European Renal Association (ERA) and the Working Group Hypertension and the Kidney of the European Society of Hypertension (ESH)

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