PRESERVATION OF THE RENAL-FUNCTION BY REV ASCULARIZATION IN RENOVASCULAR DISEASE

Renovascular disease is the leading cause of surgically-curable arteri al hypertension and one of the few cause of reversible chronic renal f ailure, but its exact prevalence remains unknown. Progression of ather omatous disease occurs in 50 % of cases and it may result in bilateral stenosis (25 %) or total occlusion (15 %). By now, the main aim of re nal revascularization is retrieval of impaired function or prevention of renal failure rather than control of hypertension. However, renal f unctional deterioration may result from cholesterol embolism or glomer ulosclerosis in addition to ischemia. Correction of post-proximal sten osis is obtained by both surgery and percutaneous angioplasty. In favo r of angioplasty are a higher acceptability and a modestly better cost -benefit ratio. Surgery may be prefered when the stenosis is proximal, complex or associated with aortic disease; in addition, analysis of p ublished (mostly uncontrolled) series suggest that beneficial renal fu nctional outcome is slightly better following surgery. Importantly, bo th diagnosis and prognosis of ischemic nephropathy are difficult to es tablish. Various predictors of recovery (renal size, renal vein renin ratio, alteration in scintigrams, angiography or biopsy) were shown to fail on an individual basis. Further controlled studies based on reli able methods of measuring renal function are war ranted.