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:
STENTS GIVE LONGER LIFE TO FAILING KIDNEYS (pp 1115-16, 1133-36)
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.