Longitudinal changes in kidney parenchymal volume associated with renal artery stenting

Modrall, J. Gregory; Timaran, Carlos H.; Rosero, Eric B.; Chung, Jayer; Plummer, Mitchell M.; Valentine, R. James; Trimmer, Clayton

doi:10.1016/j.jvs.2011.10.026

Cited by 6 publications

(2 citation statements)

References 13 publications

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“…It may be that our sample size is too small or that a natural history study would be more appropriate to examine this as the evidence from several studies has demonstrated decrease in kidney size with FL RAS. 21,22 …”

Section: Discussionmentioning

confidence: 99%

An underused opportunity to introduce ACE inhibitors and influence prognosis: observational study of patients undergoing aortic surgery

et al. 2013

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ObjectiveTo asses whether Angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) are underused in patients with aortic disease due to concerns regarding flow limiting (>70%) renal artery stenosis (RAS).DesignA prospective analysis of patients admitted for aortic surgery was performed (January–July 2009). Co-morbidity, ACEI/ARB use and renal function were recorded. Computerised tomography (CT) angiograms were reviewed by a single blinded radiologist for the presence and severity of RAS.SettingSt Mary's Hospital, Vascular Unit, Imperial College Healthcare NHS Trust, London, UK.Participants75 randomly selected patients admitted to our vascular unit including elective and emergency admissions.Main outcome measuresIndications for ACEI therapy were identified as determined by the National Institute of Health and Clinical Excellence (NICE) guidance. The ratio of the measurement distal to the stenosis and at the area of maximal stenosis on CT angiography were used to calculate the percentage RAS.Results60 patients were identified (15 patients excluded due to previously modified renal vessels). The median age was 73 [interquartile range 68, 77]. Their underlying aortic disease included 52 (87%) aortic aneurysm, 6 (10%) with aortic dissection, 1 (1.7%) patient with occlusive disease and 1 (1.7%) patient with mycotic disease. Overall, 56/60 (93%) patients had at least one indication for ACEI therapy. 33/60 (55%) of patients were already receiving ACEI. CT angiogram examination demonstrated 17/60 (28%) patients have RAS of some degree, of which only 9/60 (15%) have flow limiting RAS.ConclusionA large proportion of aortic patients do not receive ACEI/ARB therapy despite definite indications and a low prevalence of flow-limiting RAS is low. After the exclusion of RAS at angiography, careful introduction of ACEI therapy with appropriate monitoring could be considered for many more patients.

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Section: Discussionmentioning

confidence: 99%

An underused opportunity to introduce ACE inhibitors and influence prognosis: observational study of patients undergoing aortic surgery

et al. 2013

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“…(5) In addition, longer follow-up data are needed to evaluate the prognosis (32). More high-quality studies with large sample size and long follow-ups are warranted to validate these findings (33).…”

Section: Limitationsmentioning

confidence: 99%

Correlation of renal cortical blood perfusion and BP response after renal artery stenting

Wang

Zhang²,

Li³

et al. 2022

Front. Cardiovasc. Med.

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BackgroundThis study aimed to observe the correlation between renal cortical blood perfusion (CBP) parameters and BP response in patients with severe renal artery stenosis (RAS) who underwent stenting.MethodsThis was a single-center retrospective cohort study. A total of 164 patients with unilateral severe RAS after successful percutaneous transluminal renal artery stenting in Beijing Hospital from October 2017 to December 2020 were included. According to the results of BP evaluated at 12 months, all patients were divided into the BP response group (n = 98) and BP nonresponse group (n = 66). The baseline clinical and imaging characteristics and follow-up data about 24 h ABPM and CBP were recorded and analyzed. Pearson correlation analysis was used to evaluate the relationship between CBP parameters and 24 h average SBP. Univariate and multivariate logistic regression analysis was used to evaluate the risk factors for BP response.ResultsAmong 164 patients with severe RAS, there were 100 males (61.0%), aged 37–75 years, with an average of 56.8 ± 18.4 years, and average artery stenosis of 84.0 ± 12.5%. The BP nonresponse patients had a longer duration of hypertension, more current smoking subjects and diabetic patients, lower eGFR, increased number of hypertensive agents, and rate of insulin compared with the BP response group (P < 0.05). After PTRAS, patients in the BP response group were associated with significantly lower BP and improved CPB, characterized by increased levels of maximum intensity (IMAX), area under ascending curve (AUC1), area under the descending curve (AUC2), shortened rising time (RT), mean transit time (mTT), and prolonged time to peak intensity (TTP; P < 0.05). However, the BP nonresponse group was only associated with significantly reduced RT (P < 0.05) compared with baseline data. During an average follow-up of 11.5 ± 1.7 months, the BP response group was associated with significantly lower levels of SBP, DBP, 24 h average SBP, and 24 h average DBP compared with the nonresponse group (P < 0.05). Pearson correlation analysis showed that the the pre-operative CBP parameters, including IMAX (r = 0.317), RT (r = 0.249), AUC1 (r = 0.614), AUC2 (r = 0.558), and postoperative CBP parameters, including RT (r = 0.283), AUC1 (r = 0.659), and AUC2 (r = 0.674) were significantly positively correlated with the 24 h average SBP, while the postoperative TTP (r = −0.413) and mTT (r = −0.472) were negatively correlated with 24 h average SBP (P < 0.05). Multivariate Logistic regression analysis found that diabetes (OR = 1.294), NT-proBNP (OR = 1.395), number of antihypertensive agents (OR = 2.135), pre-operation IMAX (OR = 1.534), post-operation AUC2 (OR = 2.417), and baseline dDBP (OR = 2.038) were related factors for BP response (all P < 0.05).ConclusionPatients in the BP nonresponse group often have diabetes, a longer duration of hypertension, significantly reduced glomerular filtration rate, and heavier renal artery stenosis. CBP parameters are closely related to 24 h average SBP, and pre-operation IMAX and post-operation AUC2 are markers for a positive BP response.

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Updated trends in percutaneous renal arteriography among radiologists and other specialties

et al. 2023

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Longitudinal changes in kidney parenchymal volume associated with renal artery stenting

Cited by 6 publications

References 13 publications

An underused opportunity to introduce ACE inhibitors and influence prognosis: observational study of patients undergoing aortic surgery

An underused opportunity to introduce ACE inhibitors and influence prognosis: observational study of patients undergoing aortic surgery

Correlation of renal cortical blood perfusion and BP response after renal artery stenting

Updated trends in percutaneous renal arteriography among radiologists and other specialties

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