Athirakul K, McCann R, Crowley S, Conlon P, Middleton J
Surgical reversal of renal artery stenosis retards
progression of chronic renal insufficiency
Am Soc Nephrol
J Am Soc Nephrol (abstract)
(Sep) 7:1315 1996
Ischemic nephropathy is believed to be the etiology of ESRD in up to 20% of
patients. The effect of surgical revascularization of
RAS > 75% was retrospectively studied in 55 consecutive patients
over a 6-year period. The Cr was > 1.2 in 33/55 patients. Rate of
progression of CRF was determined by 1/Cr. Mean age was 61 yrs,
78% female. 50% had bilateral disease.
Two patients died
postoperatively (sepsis). In patients with CRF (Cr > 1.2), mean
preoperative Cr was 2.4, immediate post-operative creatinine was
1.8. In these patients, slope of 1/Cr vs. time was -0.073 mg/dl/mo
before and 0.035 mg/dl/mo after operation. No patient developed
ESRD (mean follow-up 32 mo). Surgical reversal of RAS slows
progression of CRF in patients with ischemic nephropathy.
Comment: These are excellent results obtained by a single surgeon
in an academic center. Whether these results can translate to
other settings is unclear. Surgical revascularization should be
considered only in selected patients, i.e. those with severe
hypertension and/or progressive renal insufficiency, since reported
operative mortality is 3-6%.
(David J. Leehey, M.D., Loyola University at Chicago)
To go back use the BACK button on your browser.
Otherwise click on the desired link to this article below:
Am Soc Nephrol
H: Special problems :
Renovascular hypertension
CRF by problem area :
Progression