Nephrology Dialysis Transplantation, Vol 14, Issue 6 1454-1461, Copyright © 1999 by Oxford University Press
D Paulsen, N Klow, B Rogstad, B Lien, K Vatne and P Fauchald
Background: the purpose of this study was to evaluate
the effects of percutaneous transluminal renal angioplasty (PTRA) on
preservation of renal function in patients with bilateral renal artery
stenoses or stenosis of the artery of one functioning kidney.
Methods: A total of 227 PTRAs of 223 stenoses in 135
patients were performed from 1982 to 1993 in a single centre and
retrospectively reviewed. The number of PTRAs per patient was 1.7, range
1-6. Angiographical follow-up was performed in 77%, 12 ± 82 days
after the first PTRA and 273 ± 245 days after the last PTRA.
Follow-up of serum creatinine and blood pressure was performed in 85% after
414 ± 558 days. Long-term follow-up was performed for dialysis,
surgical revascularization, renal transplantation and death, mean follow-up
8.8 years, range 5.5-14.8. Results: The immediate
technical success was 90%, and another 5% were improved. The primary
patency rate per patient was 43% and the secondary patency rate 64%.
Improved renal function was achieved in 23% of the patients, stabilized in
56% and failed in 21%. Stabilized or improved function was higher when
baseline serum creatinine was ⩽250 &mgr;mol/l (85%) than
>250 &mgr;mol/l (60%). Three of 99 (3%) patients with creatinine
⩽250 &mgr;mol/l started dialysis during follow-up (41 days, 7.4
and 8 years), as did 13 of 36 (36%) patients with creatinine >250
&mgr;mol/l. Blood pressure and the number of antihypertensive drugs
decreased in patients with creatinine ⩽250 &mgr;mol/l, but was
unchanged in those with creatinine >250 &mgr;mol/l. The 5-year
survival rates were 84, 66 and 17% for patients with creatinine <125
&mgr;mol/l, 125-250 &mgr;mol/l and >250 &mgr;mol/l,
respectively. Twelve patients (9%) experienced complications, including two
deaths. Conclusions: Our study shows that PTRA
improved or preserved the renal function in most patients with normal to
moderately impaired renal function. Close follow-up and possibly
re-intervention are necessary to obtain satisfactory clinical and
angiographical result. Key words: atherosclerosis;
hypertension; ischaemic renal disease; PTRA; renal artery stenosis
ORIGINAL ARTICLES
Preservation of renal function by percutaneous transluminal angioplasty in ischaemic renal disease
Department of Medicine, Department of Radiology, Institute of Transplantation Immunology and Department of Surgery, Rikshospitalet, Oslo, Norway; Corresponding author at: Lillehammer fylkessykehus, N-2600 Lillehammer, Norway
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