Contralateral Renal Function Following Unilateral Renal Artery Constriction

1982 ◽  
Vol 5 (6) ◽  
pp. 297-305
Author(s):  
Robert D. Murray ◽  
Eberhard Hackenthal ◽  
Ulrich Mittmann ◽  
Franz Gross
Keyword(s):  
Renal Function ◽  
Renal Artery ◽  
Renal Artery Constriction

The Effects of Chronic Unilateral Renal Artery Constriction on Blood Pressure, Separate Renal Function, and the Development of Collateral Circulation in the Dog

1972 ◽  
Vol 50 (12) ◽  
pp. 1170-1180 ◽  
Author(s):  
S. M. Zweig ◽  
A. Rapoport ◽  
D. R. Wilson ◽  
G. N. Ranking ◽  
H. Husdan
Keyword(s):  
Renal Function ◽  
Renal Artery ◽  
Collateral Circulation ◽  
Sodium Concentration ◽  
Aortic Pressure ◽  
Creatinine Concentration ◽  
Chloride Excretion ◽  
Renal Vascular ◽  
Two Sides ◽  
Renal Artery Constriction

In 10 dogs in each of which one kidney was left intact, unilateral renal artery constriction (R.A.C.) resulted in an increase in aortic pressure (PA) for as long as 13 months. When PA had stabilized at 156 ± 14 mm Hg compared with a baseline of 128 ± 13 mm Hg (p < 0.001) urine flow rate (V), sodium excretion (UNaV), and chloride excretion (UClV) decreased in the constricted kidney (E), while creatinine clearance (CCr) and para-aminohippurate clearance (CPAH) did not change significantly. In the contralateral control kidney (C) V, UNaV, and UClV increased, in association with increases in CCr and CPAH, but without changes in filtration fraction or renal vascular resistance. Although E/C creatinine concentration (UCr) increased as E/C V fell, E/C urine sodium concentration remained unchanged. However, when differences in V, UNaV, UClV, CCr, CPAH, and UCr between C and E were enhanced in relation to a transient exaggerated increase in PA in the acute phase following R.A.C., E/C UNa appeared to decrease slightly. When collateral circulation which had developed to E was stripped, enhanced differences in separate renal function recurred in association with a further increase in PA. Thus, chronic R.A.C. leads to the development of collateral renal circulation which appears responsible for improvement in function in E, and decrease in PA. These effects are associated with decrease in function on the control side, thereby leading to a reduction in differences in function between the two sides.

scholarly journals Clinical response scores to predict blood pressure and renal function improvement following renal artery stenting for atherosclerotic renal artery stenosis

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
A Kablak-Ziembicka ◽  
A Roslawiecka ◽  
R Badacz ◽  
A Sokolowski ◽  
P Musialek ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Logistic Regression ◽  
Renal Function ◽  
Renal Artery ◽  
Renal Artery Stenosis ◽  
Predictive Models ◽  
Artery Stenosis ◽  
Atherosclerotic Renal Artery Stenosis ◽  
Baseline Serum ◽  
Kidney Length

Abstract Background It is little known about predictors of systolic (SBP) and diastolic (DBP) blood pressure or renal function (eGFR) improvement in patients with atherosclerotic renal artery stenosis (ARAS) undergoing stent-assisted angioplasty (PTA). Therefore, we aimed to build a prediction scores that would indicate characteristics of patient subsets with ARAS most likely to have clinical improvement following PTA. Methods 201 patients who underwent PTA for ARAS (2003–2018) were categorized as eGFR or SBP/DBP responders based on eGFR increase of ≥11 ml/min/1.73m2, decrease of SBP ≥20mmHg and DBP ≥5mmHg at 12-months following PTA. The remaining patients were classified as non-responders. The performance of logistic regression models were evaluated by basic decision characteristics. Continuous data have been transformed into binary coding with help of operating characteristic (ROC) curve. Predictive models have been constructed for each followed by construction of predictive models in each of 3 categories. Results Logistic regression analysis showed that: baseline SBP&gt;145 mmHg, DBP &gt;82 mmHg, previous myocardial infarction and Renal-Aotric-Ratio &gt;5.1 were independent influencing factors of SBP response, with relative risk percentage shares of 69.8%; 12.1%; 10.9%; and 7.2%, respectively (sensitivity: 82%, specificity: 86.3%, positive (PPV):82% and negative (NPV) predictive values: 86.3%). The DBP decrease prediction model included baseline SBP &gt;145 mmHg and DBP &gt;82 mmHg, the ARAS progression, index kidney length &gt;106 mm, and bilateral PTA with respective shares of 35.0%; 21.8%; 18.2%; 13.3% and 11.8%. (sensitivity: 76%, specificity: 77.8%, PPV: 80.7% and NPV: 72.6%). The eGFR increase was associated with baseline serum creatinine &gt;122 μmol/L but eGFR greater than 30 ml/min/1.73m2, index kidney length &gt;98 mm, end-diastolic velocity in index renal artery, renal resistive index &lt;0.74, and requirement for &gt;3 BP medications, with respective shares of 24.4%; 24.4%; 21.2%; 15% and 15% (sensitivity: 33.3%, specificity: 93.5%, PPV: 65.6% and NPV: 78.9%). Conclusions Current study identified clinical characteristics of patients who most likely to respond to PTA for ARAS. The sutability of the score should be verified in a prospective cohort of patients referred to PTA of ARAS Funding Acknowledgement Type of funding source: None

Predictors for Clinical Success at One Year following Renal Artery Stent Placement

2002 ◽  
Vol 9 (4) ◽  
pp. 495-502 ◽  
Author(s):  
Trude C. Gill-Leertouwer ◽  
Elma J. Gussenhoven ◽  
Johanna L. Bosch ◽  
Jaap Deinum ◽  
Hans van Overhagen ◽  
...  
Keyword(s):  
Renal Function ◽  
Serum Creatinine ◽  
Renal Artery ◽  
Renal Artery Stenosis ◽  
Stent Placement ◽  
Clinical Success ◽  
Artery Stenosis ◽  
Renal Function Impairment ◽  
Function Impairment ◽  
Renal Artery Stent

Purpose: To determine pretreatment variables that may predict 1-year clinical outcome of stent placement for renal artery stenosis. Methods: In a prospective study, 40 consecutive patients (29 men; mean age 60 ± 9.1 years) with angiographically proven atherosclerotic renal artery stenosis were treated with stent placement because of drug resistant hypertension (n=14), renal function impairment (n=14), or both (n=12). Clinical success at 1 year was defined as a decrease of diastolic blood pressure ≥10 mmHg or a decrease in serum creatinine ≥20%, depending on the indication for treatment. Regression analysis was performed using anatomical parameters from angiography and intravascular ultrasound, estimates of renal blood flow from renal scintigraphy, and single-kidney renal function measurements. Results: Patients treated for hypertension had better outcome than those treated for renal function impairment, with clinical success rates of 85% and 35%, respectively. Preserved renal function, with low serum creatinine and high 2-kidney glomerular filtration rate at baseline, was associated with clinical success in the entire patient group at follow-up (p=0.02 and p=0.03, respectively). An elevated vein-to-artery renin ratio on the affected side was borderline predictive (p=0.06). In patients treated for renal impairment, lateralization to the affected kidney (affected kidney—to–2-kidney count ratio ≤0.45) on the scintigram emerged as a significant predictor for clinical success, with an odds ratio of 15 (p=0.048). Conclusions: Clinical success of renal artery stent placement is better for the treatment of hypertension than for preserving renal function. In patients with renal function impairment, lateralization to the affected kidney on the scintigram appears to be a predictor of clinical success.

Renal Function Salvage After Delayed Endovascular Revascularization of Acute Renal Artery Occlusion in Patients With Fenestrated-Branched Endovascular Aneurysm Repair or Visceral Debranching

2018 ◽  
Vol 25 (4) ◽  
pp. 466-473 ◽  
Author(s):  
Franziska Heidemann ◽  
Tilo Kölbel ◽  
E. Sebastian Debus ◽  
Holger Diener ◽  
Sebastian W. Carpenter ◽  
...  
Keyword(s):  
Renal Function ◽  
Renal Artery ◽  
Stent Graft ◽  
Aortic Surgery ◽  
Artery Occlusion ◽  
Aspiration Thrombectomy ◽  
Endovascular Revascularization ◽  
Renal Artery Occlusion ◽  
Local Lysis

Purpose: To analyze the renal function and outcome after delayed (>6 hours) endovascular revascularization of acute renal artery occlusion (RAO) in patients with fenestrated-branched endovascular aneurysm repairs (EVARs) or open visceral debranching. Methods: A single-center retrospective analysis was conducted involving 7 patients (mean age 61 years, range 49–72; 5 women) with 9 RAOs treated with endovascular revascularization between December 2014 and March 2017. Three patients had a solitary kidney with chronic renal insufficiency; 1 patient had bilateral occlusions as the acute event. Initial aortic surgery included 5 branched and 1 fenestrated EVAR as well as 1 open visceral debranching operation. Revascularization of the RAO was performed using aspiration thrombectomy, local lysis therapy, and stent-graft relining. The median time between initial aortic surgery and RAO was 10 months (range 0.5–17). Results: Median renal ischemic time to revascularization was 24 hours (range 7–168). Technical success was 100%, with 1 procedure-related access complication. Temporary dialysis dependency occurred in 4 patients. Mean in-hospital stay was 17 days (range 7–32) with 1 postoperative death at day 10 due to cardiac arrest of unknown cause. Mean follow-up was 10.3 months (range 1.5–27) in 5 of 6 discharged patients. During follow-up, 1 reintervention for recurrent occlusion was performed. At follow-up imaging, all renal arteries were patent. No permanent dialysis dependency occurred. Conclusion: Renal function can be salvaged by delayed revascularization for RAO with prolonged renal ischemia. The endovascular approach with aspiration thrombectomy, local lysis, and stent-graft relining is a feasible technique for revascularization after RAO in patients with fenestrated-branched EVAR or open visceral debranching.

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