Evolution of Renal Insufficiency in Ischemic Nephropathy

Abstract

This retrospective review of data collected during a recent 42-month period from 58 consecutive patients with ischemic nephropathy submitted to operative management in the authors' center was undertaken to report the rate of decline in their renal function during the period before intervention and to examine the impact of operation on their outcome. Based on serum creatinine values, immediate preoperative estimated glomerular filtration rates (EGFR) ranged from 0 to 46 mL/minute (mean, 23.85 +/- 9.76 mL/minute). Eight patients were dialysis dependent or anuric at the time of operation. Patients with at least three sequential measurements for calculations of EGFR changes during the 6 months before operation (n = 50) and the first 12 months after operation (n = 32) were used to describe the preoperative rate of decline in EGFR and the impact of operation on this decrease in the operative survivors. In addition comparative analyses of data from patients with unilateral versus bilateral lesions and patients classified as having improvement in EGFR versus no improvement after operation were performed. Comparison of the immediate preoperative EGFR with the immediate postoperative EGFR for the entire group showed significant improvement in response to operation. Likewise the rate of deterioration in EGFR for the total group was improved after operation. A similar improvement in the rate of deterioration in EGFR was seen in the subgroup of patients who received an immediate improvement in EGFR in response to operation. These data argue that ischemic nephropathy is a rapidly progressive form of renal insufficiency. Although individual responses to operation were heterogeneous, renal revascularization may provide both immediate improvement in renal function and an improvement in its rate of deterioration during follow-up in patients with ischemic nephropathy.

Successful Blood Pressure Control with Additive Administration of Eplerenone, an Aldosterone Receptor Blocker, in a Patient with Bilateral Renovascular Hypertension Treated with Angioplasty

“…In fact, administration of an angiotensin converting enzyme (ACE)-inhibitor has been shown to reduce the mortality risk in cases with renal artery stenosis (12). In patients with renovascular hypertension with bilateral renal artery stenosis, however, ARB and ACE-inhibitor could result in rapid deterioration of renal function as they have the potency to dilate the efferent arteriole from glomerulus resulting in the reduction of intra-glomerular pressure (13). In the present case, telmisartan, an ARB, had been administered before the patient visited our facility.…”

When stenting in renal artery stenosis? Update on pathophysiology of ischemic nephropathy and management strategies

“…A second apparent paradox is that the occurrence of rapidly developing anuria can play a protective role, as demonstrated by some reports 54,55 showing a total success rate in recovering renal function in anuric patients, even after several months of dialysis treatment.…”

Open operative management of dialysis‐dependent ischemic nephropathy

“…[5][6][7] Moreover, anatomic progression of RA disease in some hypertensive patients has been shown to result in a decline in kidney size and function, suggesting that ischemic nephropathy may contribute to end-stage renal disease. 3,8 This idea is supported by studies that define up to 40% of patients presenting for chronic renal replacement therapy as having RA disease. 2,9,10 Despite the recognized association between RA disease and renal insufficiency, the indications for RA intervention and the optimal management strategies that lead to significant recovery of renal function remain poorly defined.…”

“…[1][2][3] Previous reports suggest that 20%-25% of patients with renal insufficiency may have RA disease. [5][6][7] Moreover, anatomic progression of RA disease in some hypertensive patients has been shown to result in a decline in kidney size and function, suggesting that ischemic nephropathy may contribute to end-stage renal disease.…”