High grade renal artery atherosclerosis in patients with chronic renal insufficiency is not characterized by a rapid (< 6 months) decline in renal function
ASN 30th Annual Meeting, San Antonio
J Am Soc Nephrol (Sep) 8:74A 1997
High grade atherosclerotic renal artery stenosis (ASO-RAS) is believed to be a progressive disorder which may cause end-stage renal disease. A rapid decline in renal function over the 6 months prior to initiating dialysis has been reported to predict recovery of renal function following surgical revascularization. However, it is unclear how frequently rapid progression of renal failure occurs in ASO-RAS. 40 patients with high grade (>75%) stenosis (bilateral or unilateral in a solitary kidney) under observation in a randomized trial comparing medical and surgical management were evaluated. Only 1 of 40 patients had a substantial decline in GFR over an average time period of 6.7 months. Mean serum creatinines were 1.91 mg/dl at baseline and 2.03 at the end of the time period. Rapid deterioration of renal function in patients with ASO-RAS is rare.
Comment: These are much needed data and add fuel to the controversy over how to best manage patients with high grade bilateral ASO-RAS. Revascularization is probably only indicated in patients with either uncontrollable hypertension or progressive renal insufficiency. Acute deterioration of renal function is usually secondary to hemodynamic events, especially ACE inhibition, rather than progression of RAS and is reversible with medical management. (David J. Leehey, M.D., Loyola University at Chicago)
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ASN 30th Annual Meeting, San Antonio
H: Special problems : Renovascular hypertension