Renal Artery Stenosis: Medical Versus Interventional Therapy

Abstract

Reports from recent trials indicate little additional benefit from stent supported revascularization in patients with atherosclerotic renal artery stenosis. These data have been questioned, particularly on the basis of including subjects with modest occlusive disease and reports of clinical benefits to patients with episodic congestive heart failure. Nonetheless, these data have moved the pendulum away from renal revascularization as a primary maneuver to one reserved for refractory hypertension and/or progressive loss of renal function and circulatory congestion. Recent data emphasize the limits of the kidney adaptation to reduced blood flow, the eventual development of widespread renal hypoxia with activation of inflammatory and fibrogenic pathways. Experimental data now support developing adjunctive measures to support angiogenesis and anti-inflammatory renal repair mechanisms, such as those observed with cell-based therapy with mesenchymal stem/stromal cells.

Spécificités des néphropathies du sujet âgé

“…Dès lors, il apparaît souhaitable de sélectionner très strictement les patients âgés candidats à l'angioplastie. Les patients avec des tableaux d'oedèmes pulmonaires répétés, d'angor instable lié à des pics tensionnels, de dégradation rapide de la fonction rénale ou de sténose artérielle à haut risque de thrombose (surtout sur rein unique) paraissent être ceux qui tirent profit de la revascularisation [44].…”

Stem Cell Therapies in Peripheral Vascular Diseases — Current Status

“…96 Mesenchymal stem cell therapies for various types of kidney injuries have been the subject of research in many preclinical and clinical studies, most of them focusing on acute kidney injury. [97][98][99][100] The repair mechanism of mesenchymal stem cells (MSC) includes cytokine release and MSC differentiation into renal cells; MSC can be implanted intravenously, intra-arterially, or within the kidney parenchyma. 101 Ischemic chronic kidney disease caused by renal artery stenosis is characterized by glomerular fibrosis and decreased number of microvessels, with secondary triggering of the renin angiotensin aldosterone cascade, with subsequent vasoconstriction, inflammation and fibrosis.…”

Diagnosis and Treatment of Glomerular Diseases in Elderly Patients

“…On the other hand, if BP control cannot be achieved or the patient experiences progressive loss of kidney function, recurrent and refractory congestive heart failure, pulmonary edema, or unstable angina that is attributable to rapid BP rising, then further imaging studies with intent to correct the renal artery stenosis (RAS) are justified. 76 A range of radiological imaging techniques are clinically available for RAS evaluation. 77 Duplex Doppler This low-power view shows an interlobular artery with marked mucoid intimal edema.…”