Use of Doppler ultrasonography to predict the outcome of therapy for renal-artery stenosis.

BACKGROUND Prospectively identifying patients whose renal function or blood pressure will improve after the correction of renal-artery stenosis has not been possible. We evaluated whether a high level of resistance to flow in the segmental arteries of both kidneys (indicated by resistance-index values of at least 80) can be used prospectively to select appropriate patients for treatment. METHODS We evaluated 5950 patients with hypertension for renal-artery stenosis using color Doppler ultrasonography, and we measured the resistance index ([1 - end-diastolic velocity divided by maximal systolic velocity] x 100). Among 138 patients who had unilateral or bilateral renal-artery stenosis of more than 50 percent of the luminal diameter and who underwent renal angioplasty or surgery, the procedure was technically successful in 131 (95 percent). Creatinine clearance and 24-hour ambulatory blood pressure were measured before renal-artery stenosis was corrected; 3, 6, and 12 months after the procedure; and yearly thereafter. The mean (+/-SD) duration of follow-up was 32+/-21 months. RESULTS Among the 35 patients (27 percent) who had resistance-index values of at least 80 before revascularization, the mean arterial pressure did not decrease by 10 mm Hg or more after revascularization in 34 (97 percent). Renal function declined (defined by a decrease in the creatinine clearance; of at least 10 percent) in 28 (80 percent); 16 (46 percent) became dependent on dialysis and 10 (29 percent) died during follow-up. Among the 96 patients (73 percent) with a resistance-index value of less than 80, the mean arterial pressure decreased by at least 10 percent in all but 6 patients (6 percent) after revascularization; renal function worsened in only 3 (3 percent), all of whom became dependent on dialysis; and 3 (3 percent) died (P<0.001 for the comparison with patients with a resistance-index value of at least 80). CONCLUSIONS A renal resistance-index value of at least 80 reliably identifies patients with renal-artery stenosis in whom angioplasty or surgery will not improve renal function, blood pressure, or kidney survival.

[1]  M. Gebel,et al.  Detection of significant renal artery stenosis with color Doppler sonography: combining extrarenal and intrarenal approaches to minimize technical failure. , 2000, Clinical nephrology.

[2]  P. Krijnen,et al.  The effect of balloon angioplasty on hypertension in atherosclerotic renal-artery stenosis. Dutch Renal Artery Stenosis Intervention Cooperative Study Group. , 2000, The New England journal of medicine.

[3]  D. Ducassou,et al.  Value of captopril renal scintigraphy in hypertensive patients with renal failure. , 1999, Journal of nuclear medicine : official publication, Society of Nuclear Medicine.

[4]  R. Zierler,et al.  Clinical Evidence of Contralateral Renal Parenchymal Injury in Patients with Unilateral Atherosclerotic Renal Artery Stenosis , 1998, Annals of vascular surgery.

[5]  Y. Ubara,et al.  Renovascular hypertension may cause nephrotic range proteinuria and focal glomerulosclerosis in contralateral kidney. , 1997, Clinical nephrology.

[6]  L. Erdoes,et al.  Comparative analysis of percutaneous transluminal angioplasty and operation for renal revascularization. , 1996, American journal of kidney diseases : the official journal of the National Kidney Foundation.

[7]  S. Bergman,et al.  Possible mediators in hypertension: renal factors. , 1996, Seminars in nephrology.

[8]  T. Huber,et al.  Selection of patients for renal artery repair using captopril testing. , 1995, American journal of surgery.

[9]  H. Schima,et al.  Intrarenal Doppler ultrasonography: which vessel should be investigated? , 1995, Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine.

[10]  R. Limet,et al.  Surgery for occlusive renal artery disease: immediate and long-term results. , 1995, Acta chirurgica Belgica.

[11]  L. Ruilope,et al.  Are renal hemodynamics a key factor in the development and maintenance of arterial hypertension in humans? , 1994, Hypertension.

[12]  M. Prokop,et al.  The Kissing Balloons Technique , 1993, Acta radiologica.

[13]  T. Pickering,et al.  Detection of renovascular hypertension. State of the art: 1992. , 1992, Annals of internal medicine.

[14]  J. Reidy,et al.  Percutaneous transluminal renal angioplasty in patients with renal failure. , 1992, The Quarterly journal of medicine.

[15]  J. Libertino,et al.  Renal revascularization to preserve and restore renal function. , 1992, The Journal of urology.

[16]  G. Geyskes,et al.  Captopril renography and the effect of percutaneous transluminal angioplasty on blood pressure in 94 patients with renal artery stenosis. , 1991, American journal of hypertension.

[17]  P. Hoffer,et al.  Captopril renography in the diagnosis of renal artery stenosis and the prediction of improvement with revascularization. The Yale Vascular Center experience. , 1991, American journal of hypertension.

[18]  L. Svetkey,et al.  Similar Prevalence of Renovascular Hypertension in Selected Blacks and Whites , 1991, Hypertension.

[19]  T. Sos Angioplasty for the Treatment of Azotemia and Renovascular Hypertension in Atherosclerotic Renal Artery Disease , 1991, Circulation.

[20]  J. Laragh,et al.  Captopril renography in the diagnosis of renal artery stenosis: accuracy and limitations. , 1991, The American journal of medicine.

[21]  P. Waller,et al.  Blood pressure response to percutaneous transluminal angioplasty for renovascular hypertension: an overview of published series. , 1990, BMJ.

[22]  G. Schwartz,et al.  Renal parenchymal involvement in essential hypertension. , 1987, The Medical clinics of North America.

[23]  F. Keller Kidney function and age. , 1987, Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association.

[24]  Black Hr,et al.  Cigarette smoking and atherosclerotic renal artery stenosis. , 1986 .

[25]  E. J. Mees,et al.  Follow up study of 70 patients with renal artery stenosis treated by percutaneous transluminal dilatation. , 1983, British medical journal.

[26]  F. Luft,et al.  Percutaneous transluminal dilatation in the treatment of renal vascular hypertension. , 1981, Annals of internal medicine.

[27]  C. Sussman,et al.  Circulating levels of angiotensin I measured by radioimmunoassay in hypertensive subjects. , 1979, The Journal of laboratory and clinical medicine.

[28]  M. A. Johnson,et al.  Single-nephron pressures, flows, and resistances in hypertensive kidneys with nephrosclerosis. , 1977, Kidney international.