HDCN Article Review/Hyperlink

Harden P et al

Effect of renal artery stenting on the progression of renovascular renal failure

Lancet (Apr) 349:1115-1116 1997

A press release describing this paper is available from the Lancet. The press release is reproduced below:

Atherosclerotic stenosis (narrowing due to fatty deposition) of the renal arteries (ARAS) is an important cause of progressive kidney failure. Placement of tubular supports or stents in the narrowed artery to ensure it stays open has a high technical success rate in atherosclerotic renovascular disease, but up until now little has been known about the clinical benefits of the procedure. In this week's issue of The Lancet Dr Paul Harden and colleagues, from Glasgow, UK, investigate the effectiveness of this treatment.

Dr Harden and co-workers assessed kidney function before and after renal stent placement by means of serial measurement of creatinine in the blood in 32 patients with ARAS selected for renal-stent placement. Creatinine is a waste product of metabolism, which is filtered out of blood by the kidneys and excreted in urine. If the kidneys are not functioning properly creatinine concentrations in the blood rises. The effect of stent placement on progression of renal failure was analysed in 23 patients by comparing concentrations of blood creatinine before (about 17 months) and after (about 8 months) stent insertion.

Kidney function improved or stabilised in 22 (69%) of the 32 patients and progression of kidney failure was slowed significantly after the procedure. The authors conclude "we believe that our longitudinal analysis provides the best evidence to date of the benefit of stent insertion".

In a commentary (pp 1115-16), Dr Stockx and colleagues are encouraged by the results in this study and suggest that this procedure be considered as a primary procedure, rather than the more widely used balloon technique used just to widen the arteries without attempting to keep them open. However, the commentators do warn that because the procedure is technically difficult and complications after the procedure are possible, stent placement should be done in specialist centres by "well-trained interventional radiologists" who should be "supported by an experienced vascular team".

Contacts: Dr Paul Harden, Department of Nephrology, North Staffordshire Royal Infirmary, Stoke-on-Trent, UK; tel +44 (0) 782 715444. Dr L Stockx, Department of Radiology, University Hospitals KU Leuven, Leuven, Belgium; tel +32 16 343780. Please mention The Lancet as the source of this material.