Percutaneous transluminal renal angioplasty application effect on renal function in patients with renal artery stenosis: A case report on 4 patients

Abstract

Introduction. Renal artery stenosis (RAS) is narrowing of one or both renal arteries or their branches. Clinically significant stenosis involves narrowing of the lumen, which is approximately 80%. The two most common causes of its occurrence are atherosclerosis and fibromuscular dysplasia. Percutaneous transluminal renal angioplasty (PTRA) with stent implantation is an effective treatment modality that leads to lower blood pressure and improvement of kidney function. Case report. We presented 4 patients with significant stenosis of one or both renal arteries followed by the development of arterial hypertension and renal insufficiency. The causes of RAS were atherosclerosis in two patients and fibromuscular dysplasia in one patient. One of the patients had renal artery stenosis of transplanted kidney that developed 9 month after transplantation. In all the patients, in addition to clinical signs, doppler screening suspected the existence of significant renal artery stenosis. The definitive diagnosis was made by applying computed tomographic angiography (CTA) of renal arteries in 3 of the patients and in 1 patient by percutaneus selective angiography. All the patients were treated by application of PTRA with stent implantation followed by improvement/normalization of blood pressure and kidney function. Conclusion. Application of PTRA with stent implantation is an effective treatment of significant stenosis of one or both renal arteries followed by renal insufficiency.Uvod. Renalna arterijska stenoza (RAS) predstavlja suzenje jedne ili obe renalne arterije ili njihovih grana. Klinicki znacajna stenoza podrazumeva suzenje lumena koje iznosi priblizno 80%, a dva najcesca uzroka njenog nastanka su ateroskleroza i fibromuskularna displazija. Perkutana transluminalna renalna angioplastika (PTRA) sa implantacijom stenta, predstavlja efikasan modalitet lecenja koji dovodi do snizenja krvnog pritiska i poboljsanja bubrezne funkcije. Prikaz bolesnika. Prikazali smo cetiri bolesnika sa znacajnom stenozom jedne ili obe renalne arterije, pracene razvojem arterijske hipertenzije i bubrezne insuficijencije. Uzrok nastanka RAS bili su ateroskleroza kod dva i fibromuskularna displazija kod jednog bolesnika. Kod jednog bolesnika devet meseci nakon transplantacije bubrega doslo je do razvoja stenoze na mestu anastomoze renalne arterije donorskog bubrega i hipogastricne arterije recipijenta, najverovatnije uzrokovane aterosklerozom. Kod sva cetiri bolesnika pored klinickih pokazatelja, doplersonografskim skriningom postavljena je sumnja na postojanje znacajne stenoze renalne arterije. Definitivna dijagnoza postavljena je primenom multislajsne skenerske angiografije renalne arterije kod tri bolesnika, a kod jednog bolesnika selektivnom angiografijom. Sva cetiri bolesnika lecena su primenom PTRA sa implantacijom stenta, nakon cega je doslo do poboljsanja/normalizacije krvnog pritiska i bubrezne funkcije. Zakljucak. Primena PTRA sa implantacijom stenta predstavlja efikasan modalitet lecenja znacajne stenoze jedne ili obe bubrezne arterije, pracene bubreznom insuficijencijom.