Renal Revascularization in the Azotemic Hypertensive Patient Resistant to Therapy

Ying, Christopher Y.; Tifft, Charles P.; Gavras, Haralambos; Chobanian, Aram V.

doi:10.1056/nejm198410253111702

Cited by 150 publications

(28 citation statements)

References 26 publications

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“…Furthermore, while medical therapy may control blood pressure, renal function often deteriorates nonetheless. 22 Numerous approaches to the diagnosis of renovascular hypertension have been advocated enthusiastically over the last 30 years.…”

Section: Discussionmentioning

confidence: 99%

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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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Section: Discussionmentioning

confidence: 99%

“…37 The second is a well-described group of patients who also have normal blood pressures but exhibit renal insufficiency on the basis of progressive renal ischemia and may benefit from revascularization. 22 The diagnostic utUity of simplified captopril renography was not evaluated in patients of either of these first two classes.…”

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confidence: 99%

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

et al. 1991

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“…In our solitary kidney subgroup, 2 of 3 patients showed an improvement in their renal function. Encouraging results in the preservation of renal function have been reported by other centers (3,17,(38)(39)(40).…”

Section: Discussionmentioning

confidence: 61%

“…In patients with bilateral stenoses, the beneficial effects of revascularization are present especially after bilateral repair (36), although the Cleveland group reported that their results were not very different from those in patients with unilateral revascularization of only the more stenotic artery (37). In bilateral disease, both kidneys, in fact, are relatively protected from the unfavourable effects of high systemic blood pressure (3). In this study, after bilateral PTRA, 1 of 6 patients improved and in 2 of 6 patients the renal function remained unchanged.…”

Section: Discussionmentioning

confidence: 99%

“…In nonselected patient populations the prevalence is less than 1 %, while among patients referred for diagnostic studies it is between 2% and 4% (1). However, among patients with accelerated or malignant hypertension the prevalence of renovascular hypertension is about 30%, and rises to about 40% when renal insufficiency is present (2,3). Currently available potent and well tolerated antihypertensive drugs have greatly improved the medical management of patients with renovascular hypertension.…”

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Percutaneous Transluminal Renal Angioplasty in Patients with Renovascular Hypertension: Long-Term Results.

et al. 1995

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This study evaluated the long-term effects of percutaneous transluminal renal angioplasty (PTRA) on blood pressure and renal function in patients with renovascular hypertension. Seventy-eight patients with hypertension and unilateral or bilateral stenoses of the renal arteries (16 with fibromuscular dysplasia and 62 with atherosclerosis) were studied. All patients with fibromuscular dysplasia (group A) had normal renal function, while 27 of the 62 patients with atherosclerosis (group B) presented with various degrees of renal failure. PTRA was technically successful in 87.5% patients of group A. The overall technical success rate (complete plus partial) was 72.3% (55/76 renal arteries) in group B. Mean follow-up (range) in months was 42 (12-108) for group A and 39 (13-106) for group B. After successful PTRA, the overall benefit rate (cure plus improved) for hypertension was 100% in group A; 10 of 14 patients were cured and 4 of 14 were improved. In group B, the overall benefit rate was 70.8% ; 9 of 48 were cured and 25 of 48 were improved. PTRA was technically successful in 18 of 27 patients with renal failure. Renal function improved in 4 of 18 patients, remained stable in 9 of 18, and deteriorated in 5 of 18 patients. The above results suggest that PTRA is an effective method for the long-term management of patients with renovascular hypertension, although the results were less favorable in the presence of bilateral renal artery stenoses: in addition to improved control of blood pressure, PTRA might improve renal function or delay its progressive deterioration. (Hypertens Res 1995; 18: 27-31)

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Chronic Renal Insufficiency

Rahman

Smith

1998

Arch Intern Med

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Renal Revascularization in the Azotemic Hypertensive Patient Resistant to Therapy

Cited by 150 publications

References 26 publications

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

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

Percutaneous Transluminal Renal Angioplasty in Patients with Renovascular Hypertension: Long-Term Results.

Chronic Renal Insufficiency

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