PP.39.10: UNILATERAL DILATATION AND STENTING OF RENAL ARTERY STENOSIS IN A PATIENT UNDERGOING HEMODIALYSIS IMPROVES RENAL FUNCTION AND DECREASES BLOOD PRESSURE. LONG-TERM RESULTS. (June 2015)

• Record Type: Journal Article
• Authors: Neumann, C.; Matzath, S.; Schettler, V.; Hagenah, G.; Özcelik, C.; Schulz, E.
• Is Part Of: Journal of hypertension. Volume 33(2015)Supplement 1
• Publication Date: 2015-06
• Subjects: Hypertension -- Periodicals; Hypertension -- Periodicals; 616.132005
• DOI: 10.1097/01.hjh.0000468922.35239.c8
• Languages: English
• ISSNs: 1473-5598

Abstract

Abstract : Objective: The therapeutic procedure for the treatment of atherosclerotic renal artery stenosis is subject to controversy. Current guidelines however stipulate a consistent screening for indications of secondary hypertension. Design and method: Female, 81 years, impaired general condition, lower leg edema, over the course of 6 months increasing uremia: pruritus, inappetence, fatigue, loss of appetite, nausea. Dx: 1998 coronary heart disease, 1999 hypertensive nephrosclerosis. Antihypertensive therapy (6-fold, full-dose). Regular- and color-coded kidney-duplex-sonography: Left: Cirrhosis of kindney, no flow signal. Right: 9.4 cm x 4.5 cm x 5.0 cm. Due to uremia initiation of hemodialysis treatment via Demers-Catheter. Intervention/angiography: Filifom, severely calcified ostial stenosis of the right renal artery, functional subtotal occlusion. Profound ostial stenosis and cirrhosis of the left kidney. Blood pressure 190/105 mmHg. Multiple percutaneous transluminal catheter angioplasty/ cutting balloon intervention. Subsequent bare metal stent implantation (Liberte 5.0 mm x 16 mm), followed by immediate high-pressure post-dilatation. Post interventional abrupt drop in blood pressure to high-normal values. Results: After three weeks of three hemodialysis treatments each, the therapy could be discontinued. After two years blood tests still provide stable laboratory values in the asymptomatic patient. (Lab values, Tab. 1). The required antihypertensives intake was significantly reduced (4-fold, mid-dose after one year and 3-fold mid-dose after two years) while maintaining optimal blood-pressure values (ABPM). Color-coded duplex-sonography confirmed excellent perfusion of the right kidney consistently over the course of one year and even two years after dilatation (Duplex parameters, Tab. 2). Figure. No caption available. Conclusions: Our case confirms the importance of a patient-centered, individual decision for or against interventional treatment of atherosclerotic renal artery stenosis. Here, both reduction of blood pressure and preservation of renal function have to be considered. On the left handside cirrhosis of the kidney was diagnosed (< 8 cm) with a complete absence of perfusion signal. On the contrary, parameters of the right kidney (> 9 cm, Parenchyma-RI < 0.8) allowed hemodynamic as well as functional success of an intervention to be expected. Even after two years blood pressure is well controlled under reduced medication and dialysis is still not become necessary.