Tratamento endovascular da estenose da artéria renal em rim único

Abstract

Background: Endovascular treatment of hypertensive renal disease in patients with a solitary kidney secondary to renal artery stenosis proved to be effective to prevent organ failure and function, as well as hypertension control. When indicated after judicious evaluation using both biochemical methods and the patient's images and signs, endovascular treatment has effective clinical benefits and is little invasive. Objective: To study renal artery stenosis with hypertension and evaluate the effectiveness of endovascular treatment in the control of hypertension, renal failure secondary to renal artery stenosis, and in the prevention of renal failure in patients with a solitary kidney. Methods: This study was performed at the Reference Center of High Complexity in Endovascular Surgery of Hospital de Cl‚nicas da Universidade de Campinas from April 1997 through June 2005 using a previously developed protocol. Ten patients with renal artery stenosis and solitary kidney submitted to endovascular treatment were included. Improvement in hypertension and renal function was assessed through clinical follow-up and laboratory tests using measurements of blood pressure, serum urea levels, creatinine and clearance. Color-flow Doppler ultrasound was performed 30, 90, 180 days after the surgery and yearly thereafter. Aortography and selective renal arteriography were performed in case of doubt as to images or signs. For this population, 90% had hypertension, 70% were smokers, 40% had hyperlipidemia, 30% had carotid artery occlusive disease, 60% had chronic lower limb arterial occlusion, and 20% had diabetes mellitus. Results: Immediate success was 100%. Mean follow-up time was 40 months. Control of blood pressure occurred in 90% of the cases, and in 10% there was significant reduction in urea and creatinine levels and worsening of hypertension after the procedure. Conclusion: Endovascular treatment of renal artery stenosis is a technique that has clinical benefits in hypertension control, preserving renal function and progression of this disease, but without improvement in renal function.

Tratamento da recidiva de reestenose intra-stent renal por angioplastia com balão farmacológico

“…15 Despite the initial appeal to invasive treatment of atherosclerotic lesions of the renal arteries, questions are now asked about its true benefits in terms of preventing progression of chronic kidney disease and for real control of blood pressure levels. [16][17][18][19] In the case described here, the indication for angioplasty derived from the need for renal revascularization to treat atherosclerotic disease involving the only kidney.…”

“…[16][17][18][19][20][21] A meta-analysis found a restenosis rate of 26% after balloon angioplasty and 17% after angioplasty with stents, 3 which supports the use of primary stenting (class I) for ostial stenosis of the renal artery, when the indications for endovascular intervention are respected. Restenosis rates after renal stent angioplasty with satisfactory initial results varied in the range of 6-40%, depending on the diameter of the vessel treated, the characteristics of the lesion, and the patient's comorbidities.…”

Resultados a longo prazo da angioplastia de artérias renais com stent na doença aterosclerótica: revisão sistemática

“…Clinically, it can present as renovascular hypertension and ischemic renal disease, causing long-term systemic complications. 1,2 This pathology is associated with increased cardiovascular risk and elevated mortality. [3][4][5][6] For the purposes of research and treatment, many authors define renal artery stenosis as critical when it is greater than 60%.…”

Resultados a longo prazo da angioplastia das artérias renais na doença aterosclerótica

“…Define-se como estenose crítica da artéria renal aquela maior que 60% de grau de obstrução 1,2 . Porém existem divergências na literatura, com autores que consideram estenose crítica toda estenose maior que 50 ou 70%.…”

“…Dentre os diuréticos de escolha temos os de alça e os tiazídicos. Nos pacientes com estenose bilateral, observa-se um hipervolemia maior em comparação a estenose unilateral, sendo recomendado o uso dos diuréticos com maior frequência 2 . Lembrar sempre que a associação de espironolactona em doentes com insuficiência renal e uso contínuo de IECAs, podem elevar a incidência de hipercalemia 62 .…”