Different outcomes of atherosclerotic renal artery stenosis managed with stenting: results from a cohort study.

Nephrology Dialysis Unit, San Giovanni di Dio Hospital, Firenze, Italy.
Renal Failure (Impact Factor: 0.78). 01/2012; 34(2):142-8. DOI: 10.3109/0886022X.2011.646807
Source: PubMed

ABSTRACT To determine whether the type of renal artery stenosis and the rapid decline of renal function may have an impact on renal outcome after stenting.
Thirty patients with chronic kidney disease stages 3-4 and renal artery stenosis underwent stenting. The mean follow-up was 33 months; the change of estimated glomerular filtration rate was expressed as negative or positive value in mL/mo (ΔGFR). We identified two types of subgroups, on the basis of stenosis type: 1 (unilateral) N = 13 and 2 (7 bilateral, 2 single kidney, 8 prevalent kidney) N = 17; on the basis of declining ΔGFR in a pre-stenting period of 10 months: slow progressor (N = 11) and fast progressor (N = 13).
Thirty-seven stents were placed successfully. After stenting the median ΔGFR value was significantly greater in subgroup 2 compared with subgroup 1 (0.02 vs. -0.16; p = 0.02). Being in fast progressor and in subgroup 2 were associated with improved renal function after stenting (8 of 13 patients, p = 0.013; 11 of 17 patients, p = 0.032). In a logistic regression the only significant relationship is between improvement of renal function and rapid decline of pre-stenting GFR (odds ratio 16; p = 0.005).
The predictable benefit from renal stenting may be most likely in patients presenting with a rapid decline of GFR associated with renal artery stenosis affecting the whole renal mass that is both kidneys or single functioning kidney.

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