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J Am Soc Nephrol 12:1475-1481, 2001
© 2001 American Society of Nephrology

Long-Term Effects of Arterial Stenting on Kidney Functionfor Patients with Ostial Atherosclerotic Renal Artery Stenosis and Renal Insufficiency

JAAP J. BEUTLER*, JACOBINE M. A. VAN AMPTING*, PETER J. G. VAN DE VEN*, HEIN A. KOOMANS*, FREDERIK J. A. BEEK{dagger}, AREND-JAN J. WOITTIEZ{ddagger} and WILLEM P. T. M. MALI{dagger}

* Departments of Nephrology and Hypertension, University Medical Center, Utrecht, The Netherlands.
{dagger} Department of Radiology, University Medical Center, Utrecht, The Netherlands.
{ddagger} Department of Internal Medicine, Twenteborg Hospital, Almelo, The Netherlands.

Correspondence to Dr. Jaap J. Beutler, Department of Nephrology and Hypertension, University Medical Center, Room F03.226, P.O. Box 85500, 3508 GA Utrecht, The Netherlands. Phone: 31-30-2507329; Fax: 31-30-2543492; E-mail: j.j.beutler{at}digd.azu.nl

Abstract. It is uncertain whether renal artery stent placement in patients with atherosclerotic renovascular renal failure can prevent further deterioration of renal function. Therefore, the effects of renal artery stent placement, followed by patency surveillance, were prospectively studied in 63 patients with ostial atherosclerotic renal artery stenosis and renal dysfunction (i.e., serum creatinine concentrations of >120 µmol/L (median serum creatinine concentration, 171 µmol/L; serum creatinine concentration range, 121 to 650 µmol/L). Pre-stent renal (dys) function was stable for 28 patients and declining for 35 patients (defined as a serum creatinine concentration increase of >=20% in 12 mo). The median follow-up period was 23 mo (interquartile range, 13 to 29 mo). Angioplasty to treat restenosis was performed in 12 cases. Five patients reached end-stage renal failure within 6 mo, and this was related to stent placement in two cases. Two other patients died or were lost to follow-up monitoring within 6 mo, with stable renal function. For the remaining 56 patients, the treatment had no effect on serum creatinine levels if function had previously been stable; if function had been declining, median serum creatinine concentrations improved in the first 1 yr [from 182 µmol/L (135 to 270 µmol/L) to 154 µmol/L (127 to 225 µmol/L); P < 0.05] and remained stable during further follow-up monitoring. In conclusion, stent placement, followed by patency surveillance, to treat ostial atherosclerotic renal artery stenosis can stabilize declining renal function. For patients with stable renal dysfunction, the usefulness is less clear. The possible advantages must be weighed against the risk of renal failure advancement with stent placement.




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