ISCHEMIC DISEASE OF THE KIDNEY - HOW AND WHY TO CONSIDER REVASCULARIZATION

With increasingly accurate non-invasive tests, the clinician frequentl y discovers obstruction of the renal arteries by atherosclerosis, The decision to reverse this obstruction is not straightforward, particula rly when blood pressure can be easily controlled with medications, Pro per management of this problem requires knowledge of the accuracy of t he diagnosis, the natural history of the disorder, and the outcomes of possible interventions. This review will emphasize the value of a var iety of noninvasive tests, the consequences of allowing the arteries t o remain obstructed, and the long-term results from reversing renal ar tery obstruction. Surgical and non-surgical interventions will be exam ined, incuding percutaneous angioplasty, angioplasty with wall stentin g, surgical atherectomy, and surgical bypass procedures. In contempora ry practice hypertension is routinely recognized and aggressively trea ted regardless of the etiology. Therefore preservation of kidney funct ion is becoming an increasingly important clinical goal. This review w ill pursue a unified approach to renal artery obstruction and emphasiz e the goal of preserving glomerular filtration rate.