Ischemic nephropathy: Detection and therapeutic intervention

Abstract

Although the real prevalence of ischemic nephropathy as a cause of end-stage renal disease is unknown, its incidence has increased in past years. The diagnosis of this pathology requires that a number of functional and anatomic tests be carried out. The initial approach should be to perform duplex Doppler ultrasonography which, besides providing data on the size and extent of the stenosis, enables the intrarenal resistive index to be estimated to determine the pattern of renal parenchyma injury and the expected progression if revascularized. The most frequently used morphologic techniques are magnetic resonance angiography and computer tomography angiography. In the event of ischemic neuropathy, it is necessary to perform a renal arteriography regardless of the inherent risks of contrast toxicity or atheroembolism. Various therapeutic options are reviewed, with emphasis on percutaneous transluminal renal angiography plus stent as the first indication. Even though initial reports were contradictory, several meta-analyses have concluded that better blood pressure control and renal function improvement are achieved with percutaneous transluminal renal angiography plus stent than with conventional medical therapy. Surgical revascularization is preferable in patients with severe aorto-iliac pathology and renal artery ostium complete thrombosis. The risks and benefits of these procedures must be evaluated on an individual basis.

Different Risk Factors and Causes for Early Death after Initiating Dialysis in Diabetic and Non-Diabetic Patients

“…Vascular nephropathy stands for a heterogenous group of patients with vascular diseases and is also referred to as ischemic nephropathy. [6,7] In the present study, the diagnosis of vascular disease was based on the demonstration of a normal urine sediment without proteinuria and reduced kidney size in the ultrasonography investigation. In two cases, the diagnosis was additionally established by renal biopsy.…”

Nefroangioskleroza i ishemijska bolest bubrega - dijagnostički izazov

“…Angiografija primenom magnetne rezonanace je neinvazivna metoda, takođe visoke senzitivnosti i specifičnosti, ali veoma skupa. Renalna arteriografija uz primenu niskomolekularnog kontrasta je zlatni standard u dijagnostici stenoze renalne arterije, jer omogućava odlično prikazivanje svih krvnih sudova bubrega [23,27,28].…”

Renal Artery Stenosis and Acute Pulmonary Edema-A Possible Correlation beyond Pickering Syndrome

“…In such cases, RAS is associated with a critical decrease in the perfusion pressure of the kidneys that triggers the activation of the renin-angiotensin-aldosterone system (RAAS) with two possible consequences: the occurrence of renovascular hypertension and the development of ischemic nephropathy-defined as a reduction in glomerular filtration rate (GFR) in patients with hemodynamically significant renovascular disease affecting the entire functional renal parenchyma. Initially, this condition has been defined as plasma creatinine concentrations higher than 1.5 mg/dl [3][4][5][6][7]. Sometimes, RAS remains asymptomatic even if higher than 50%.…”