REVERSIBILITY OF ATHEROSCLEROTIC RENOVASCULAR DISEASE
65
artery stenosis.8. In our study, no association was
found between proteinuria and response to PTRA.
Clinical manifestations of generalized athero-
sclerosis were included as covariables in multi-
variate analysis as a further indication of renal
vascular damage; however, neither ischemic heart
disease, peripheral vascular disease, nor previ-
ous cerebrovascular disease was significantly
associated with renal function outcome after re-
nal angioplasty. It has been suggested that in the
presence of clinical manifestations of general-
ized atherosclerosis, PTRA resulted in less effec-
tive preservation of renal function.5 Probably in
these patients, long-standing vascular obstruc-
tion already had resulted in a relatively greater
degree of irreversible damage of renal paren-
chyma.
In conclusion, in our study a greater rate of
renal failure progression in patients with signifi-
cant renal artery stenosis is associated with a
favorable response after PTRA. This suggests
that PTRA might be beneficial in patients with
renal artery stenosis who develop acute changes
in renal function even if there is an additional
underlying renal pathological condition.
6. Harden PN, MacLeod MJ, Rodger RSC, Baxter GM,
Connell JMC, Dominiczak AF, Junor BJR, Briggs JD, Moss
JG: Effect of renal-artery stenting on progression of renovas-
cular renal failure. Lancet 349:1133-1136, 1997
7. Hansen KJ, Thomason B, Craven TE, Fuller SB, Keith
DR, Appel RG, Dean RH: Surgical management of dialysis-
dependent ischemic nephropathy. J Vasc Surg 21:197-211,
1995
8. Conlon PJ, O’Riordan E, Kalra PA: New insights into
the epidemiologic and clinical manifestations of atheroscle-
rotic renovascular disease. Am J Kidney Dis 35:573-587,
2000
9. Jacobson HR: Ischemic renal disease: An overloked
clinical entity? Kidney Int 34:729-743, 1988
10. Farmer CKT, Cook GJR, Blake GM, Reidy J, Scoble
JE: Individual kidney function in atherosclerotic nephropa-
thy is not related to the presence of renal artery stenosis.
Nephrol Dial Transplant 14:2880-2884, 1999
11. Radermacher J, Chavan A, Bleck J, Vitzthum A,
Stoess B, Jan Gebel M, Galnski M, Martin Koch K, Haller
H: Use of Doppler ultrasonography to predict the outcome
of therapy for renal-artery stenosis. N Engl J Med 344:410-
417, 2001
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fibrosis. J Am Soc Nephrol 7:2495-2508, 1996
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14. Omae T, Masson GMC: Reversibility of renal atro-
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J Clin Invest 39:21-27, 1990
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An attractive hypothesis is that rapid decline
in renal function reflects the acute hemodynamic
change induced by renal artery stenosis and
probably allows the identification of renal func-
tional mass associated with reversibility after
PTRA.
A prospective study is needed to validate the
slope preangioplasty as a marker of response to
PTRA.
16. Nawar T, Lefebvre R, Rojo-Ortega JM, Cartier P,
Genest J: Reversal of ischemic tubular atrophy. Ann Intern
Med 72:529-532, 1970
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renal tubular atrophy in experimental renovascular hyperten-
sion: A model of kidney hibernation. Nephron 72:243-252,
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18. Burn S, Caplin JL: Myocardial hibernation. Br J
Hosp Med 53:395-402, 1995
19. Matsusaka T, Hymes J, Ichikawa I: Angiotensin in
progressive renal diseases: Theory and practice. J Am Soc
Nephrol 7:2025-2043, 1996
ACKNOWLEDGMENT
The authors thank Marta Pulido, MD, for editing the
manuscript and editorial assistance.
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