Duration of blood pressure elevation in accurately predicting surgical cure of renovascular hypertension

Hughes, John S.; Dove, Henry G.; Gifford, Ray W.; Feinstein, Alvan R.

doi:10.1016/0002-8703(81)90129-0

Cited by 41 publications

(18 citation statements)

References 19 publications

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“…Or, they may have been functional renovascular hypertensives whose lesions have progressed to the point of irreversible ischemic renal injury. In support of this idea is work by Hughes and associates, 39 who showed that patients with longer durations of hypertension experienced poorer outcomes following surgery. Our data strongly suggest that the lack of captopril-induced changes on the postcaptopril scintigram wih" distinguish such patients with anatomic renal artery stenosis from those with functional renal artery stenosis and thus permit the former group to avoid revascularization procedures that are highly likely to fail.…”

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confidence: 91%

Simplified captopril renography in diagnosis and treatment of renal artery stenosis.

et al. 1991

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To improve the diagnosis and forecast the response to surgery or renal angioplasty in patients with hypertension and renal artery stenosis, we employed a simplified captopril renography protocol in conjunction with renal arteriography in 94 clinically selected patients. Fifty hypertensive patients (group 1) with a high clinical likelihood of renovascular hypertension were evaluated using a simplified captopril renography protocol and renal angiography on the arterial side. Criteria for normal captopril renal scintigrams were established based on this original cohort and validated in an additional 44 clinically comparable patients (group 2). Renal revascularization or nephrectomy was performed in 39 patients, and success of the procedure was determined in the 34 patients for whom 3-month follow-up was available. In the 94 patients, 44 (47%) had renal artery stenosis. Simplified captopril renography was 91% sensitive and 94% specific in identifying or excluding renal artery stenosis in the combined group, with no difference in the diagnostic utility between groups 1 and 2, or in those with renal insufficiency (n=38) or those with bilateral disease (n=17). Scintigraphic abnormalities induced by captopril were strongly associated with cure or improvement in blood pressure control following revascularization or nephrectomy (15 of 18), while the lack of captoprilinduced changes was associated with failure of such intervention (13 of 16) (/?=0.0004). We conclude that simplified captopril renography is highly sensitive and specific in the diagnosis of renal artery stenosis in a clinically selected high-risk population and that the test accurately predicts the success or failure of therapeutic intervention. {Hypertension 1991; 18:289-298)

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confidence: 91%

Simplified captopril renography in diagnosis and treatment of renal artery stenosis.

et al. 1991

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“…A long-lasting successful dilatation was shown in 3 patients (No. 2,7,8) by the follow-up angiography per formed 9-12 months after the PTRA; in these patients, in fact, no changes in the arterial lumen were observed when comparing the renal angiogram of the follow-up arterio graphy to that performed I h after PTRA. In the remain ing patients (No.…”

Section: Effects O F Ptra On Renal Artery Stenosismentioning

confidence: 75%

“…The medical antihypertensive therapy, in fact, does not res train the progression of the renal arterial lesion and in some cases it may cause reversible [1][2][3] or irreversible renal failure because of total thrombosis of the renal artery [4,5], The surgical therapy of the renal artery stenosis, on the other hand, has been demonstrated to involve a high risk of morbidity and mortality [6,7]; this risk is even greater in patients with a solitary functioning kidney, especially when associated with severe and longlasting arterial hypertension [8], and disseminated ather osclerosis [6,7], An alternative to the surgical therapy may be the percutaneous transluminal renal angioplasty (PTRA) [9].…”

Section: Introductionmentioning

confidence: 99%

Treatment of Severe Renovascular Hypertension by Percutaneous Transluminal Renal Angioplasty in Patients with Solitary Functioning Kidney

Russo

Iaccarino²,

Conte

et al. 1988

Nephron

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In this study the effects of percutaneous transluminal renal angioplasty on blood pressure and renal function were studied in 9 hypertensive patients with stenosis of the main artery of a solitary functioning kidney. The outcome of the percutaneous dilatation of the renal artery stenosis, and the effects on blood pressure and renal function were evaluated for a mean period of 16.4 ± 2.13 (SE) months (ranging from 3 to 65 months). A successful dilatation of the renal artery stenosis was shown in all the patients by the aortography performed 1 h after the procedure. At the discarge (7.8 ± 0.9 days after dilatation), blood pressure was ‘cured’ in 2 patients and ‘improved’ in the remaining patients; renal function was improved in all patients who had reduced renal function. At the last follow-up, no restenosis was found in patients who repeated the follow-up angiography; blood pressure was ‘cured’ in 3 patients and ‘improved’ in 6 patients, and renal function appeared steadly improved. In contrast with other reports, our results demonstrate that percutaneous renal angioplasty is a safe and effective procedure and should be attempted before considering surgical intervention in patients with artery stenosis of a solitary functioning kidney.

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“…Perhaps most important is recognizing the tempo of relatively rapid progression of both hypertension and renal dysfunction (i.e., weeks and months as opposed to years). Several reports indicate that recovery of renal function and BP benefits is correlated with relatively recent progression of vascular disease (15,16). How long is too long?…”

Section: Discussionmentioning

confidence: 99%

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2014

Clinical Journal of the American Society of Nephrology

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This case represents an individual with accelerating hypertension and declining kidney function associated with atherosclerotic renal artery stenosis. Key features include loss of GFR (reaching stage V CKD) during intensified antihypertensive drug therapy including agents that block the renin-angiotensin system and failure to appreciate the extent to which moderate renal artery stenosis was affecting his better kidney. Interpretation of duplex ultrasound studies was complicated by a discrepancy between near-normal peak systolic velocities and markedly abnormal segmental arterial waveforms. It was essential to recognize that both kidneys were abnormal and focus on recovery of perfusion to the better of these kidneys. Successful revascularization of one kidney allowed major improvement in GFR and BP control.Clin J Am Soc Nephrol 9: 1117-1123, 2014. doi: 10.2215/CJN.09030813 Case SummaryA 74-year-old retired businessman was referred for CKD stages 4 and 5 associated with an atrophic kidney, accelerated hypertension, and consideration for RRT, including renal transplantation. His history was notable for a remote history of smoking, hypertension for more than 25 years, and emergent surgical repair of a leaking abdominal aortic aneurysm 12 years previously. During the previous 2 years, he was hospitalized two times for malignant phase hypertension. In one instance, he had transient facial and upper extremity weakness associated with arterial pressures of 240/125 mmHg. Symptoms improved as BP fell with therapy. Eight months later, he was readmitted with symptoms of encephalopathy and dyspnea, again with BP above 230/120 mmHg. Initial evaluation showed a small kidney (8.6 cm by ultrasound) on the right and a left kidney of normal size (12.5 cm). Serum creatinine had risen over this period from 1.3 to 2.5 mg/dl. It rose to 3.8 mg/dl over the 1 month before referral.Renal arteriography 6 months ago showed a highgrade right renal artery stenosis (RAS) and moderate left RAS. An attempt at stenting the right renal artery was unsuccessful, attributed to severe atherosclerosis and vascular tortuosity.Medications at this time included aliskiren, 150 mg every day; carvedilol, 25 mg two times per day; clonidine, 0.3 mg three times per day; minoxidil, 2.5 mg two times per day; valsartan, 160 mg two times per day; furosemide, 80 mg in a.m. and 40 mg in p.m.; aspirin, and darbopoeitin-a, 60 mcg subcutaneously one time per week. He was also taking omeprazole, aspirin, clopidogrel, and vitamin D2.Examination was remarkable for BP5146-182/70 mmHg and body mass index of 28.1. He was fully alert without neurologic deficits. Carotid, epigastric, and lower abdominal bruits were audible. Cardiac rhythm was regular with a fourth heart sound. A well healed abdominal scar was evident. There was a trace of edema.Laboratory values included hemoglobin, 11.5 g/dl; hematocrit, 34%; white blood cell count, 4300; platelets, 92,000/ml; BUN, 57 mg/dl; sodium, 138 meq/L; potassium, 5.1 meq/L; bicarbonate, 29 meq/L; and chloride, 97 meq/L. Serum ...

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Duration of blood pressure elevation in accurately predicting surgical cure of renovascular hypertension

Cited by 41 publications

References 19 publications

Simplified captopril renography in diagnosis and treatment of renal artery stenosis.

Simplified captopril renography in diagnosis and treatment of renal artery stenosis.

Treatment of Severe Renovascular Hypertension by Percutaneous Transluminal Renal Angioplasty in Patients with Solitary Functioning Kidney

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