CHSJ

Curr Health Sci J, vol. 36, no. 4, 2010

Renal Artery Stenosis Due To Ischemic Nephropathy

[Original paper]

Alina-Gabriela Pauna

Department of Nephrology, “St. John” Emergency Hospital, Bucharest


Abstract:

This paper approach a relatively old problem: renovascular hypertension in atherosclerotic renal artery stenosis, and a relatively new one: ischemic nephropathy. In recent years, ischemic nephropathy has been recognized as a cause of increasingly frequent chronic renal failure that requires initiation of alternate therapy failure. This has led to the develop-ment of new methods of diagnosis and treatment of vascular stenosis, such as Duplex ultrasonography, spiral CT, MRI angiography, selective renal angio-graphy that provide morphological and functional proper diagnosis in all cases. Were followed 386 patients with renal failure (203 with acute renal failure and 183 with rapidly progressive renal failure) hospitalized in Depart-ment of Nephrology, “St. John” Emergency Hospital Bucharest between 2006 and 2009. Of these, 85 patients had hypertension and were investigating the direction of possible secondary hypertension, renal origin. Only 16 were found to have renovascular hypertension and were the group of interest in this article. Have been performed screening tests for possible renal artery stenosis: with and without renal scintigraphy, Doppler ultrasound, renal arteriography. Scintigraphy changes were present in 11 of the 16 patients before Captopril administration. At four of them, the changes occurred after Captopril administration. Doppler ultrasound was performed at seven of the 16 patients watching the morphology of renal arteries, blood flow aspect, velocity and resistivity indices. Only five of the seven patients had changes suggestive, the two could not be performed because of obesity. Arteriography has been performed at all patients and showed atherosclerotic lesions at 11 patients (five of them with bilateral lesions), fibromuscular dysplasia in three patients (one with bilateral lesions), one case of abdominal aorta with dissection extended to the renal arteries and one with renal artery hypoplasia. Corrections artery stenosis was performed in seven patients: angioplasty – one case, angioplasty with stent implantation – five cases and unilateral nephrectomy with angioplasty and contralateral stent – one case. In long term were followed only six patients. Normalization of blood pressure was obtained at one patient (angioplasty on single stenosis without poststenotic dilatation), with normalization of renal function; at the other six, arterial hypertension has improved slightly, with reduction of antihypertensive drugs and stops the deterioration of renal function.


Keywords: ischemic nephropathy, renal artery stenosis, renovascular hypertension, chronic renal failure



Corresponding: Alina-Gabriela Pauna, MD, Nephrology Specialist, PhD, Department of Nephrology, "St. John" Emergency Hospital, 13 Vitan-BArzesti Highroad, Sector 4, 042122 Bucharest, Romania; Phone +4021-334 50 75, Fax +4021-334 59 70, e-mail: alina.pauna76@yahoo.co.uk


DOI 10.12865/CHSJ.36.04.04 - Download PDF
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