Ns. Nahman et al., RENAL-ARTERY PRESSURE-GRADIENTS IN PATIENTS WITH ANGIOGRAPHIC EVIDENCE OF ATHEROSCLEROTIC RENAL-ARTERY STENOSIS, American journal of kidney diseases, 24(4), 1994, pp. 695-699
From October 1979 to August 1991, 231 patients undennrent renal artery
balloon angioplasty at The Ohio State University Hospitals. Atheroscl
erotic renal vascular disease was present in 171 of these patients. Fr
om this cohort, 138 patients undergoing their first angioplasty had re
nal artery pressure gradients performed before and after renal artery
angioplasty. The demographics of this group included age 66.9 +/- 10 y
ears (+/- SD), male 51%, white 94%, black 6%, diabetes mellitus 28%, s
ystolic blood pressure 157 +/- 26 mm Hg, diastolic blood pressure 86 /- 13 mm Hg, standard daily doses of antihypertensive medications 4.2
+/- 3, and serum creatinine 2.6 +/- 2.3 mg/dL. Plasma renin activity w
as measured in 25 patients and was shown to be elevated in 16. The ren
al artery stenoses were main renal artery 75%, orificial 22%, distal r
enal artery 1.4%, and combinations of the above 2.2%. Solitary kidneys
were present in six patients (4.3%). Bilateral renal artery stenosis
was present in 45% of patients and bilateral angioplasties were perfor
med in one third of these patients. The preangioplasty systolic blood
pressure gradient was 109 +/- 50 mm Hg (range, 20 to 230 mm Hg) and th
e postangioplasty renal artery pressure gradient was 12 +/- 16 mm Hg (
range, 0 to 78 mm Hg) (P < 0.001). There were no complications related
to measurement of the pressure gradients. The magnitude of the renal
artery pressure gradients did not correlate with blood pressure level,
number of antihypertensive medications, or serum creatinine level. In
conclusion, measurement of renal artery pressure gradients is safe an
d useful in defining hemodynamic significance and immediate response t
o angioplasty of stenotic renal artery lesions. Whether the reduction
in renal artery pressure gradients achieved by the angioplasty is a pr
edictor of the long-term success of the procedure is the subject of an
ongoing study. (C) 1994 by the National Kidney Foundation, Inc.