Predicting the outcome of invasive treatment of renal artery disease

Objective. Analysis of the factors influencing the outcome of performed or attempted invasive treatment for renal artery disease (RAD). Setting. University Hospital. Study patients. Thirty-five hypertensive patients with 31 stenoses and 14 o cclusions of renal artery. Interventions. Angioplasty was performed on 25 patients (attempted for 30), primary stenting on one, nephrectomy on three, and renal resection on one patient. Main outcome measure. A decrease of diastolic blood pressure (DBP) by great er than or equal to 15 mmHg after intervention. Results. A DBP response was seen in 24 patients. In II patients, invasive t reatment did not result in a DBP response or failed technically. Compared w ith these patients, the responders were younger (55 +/- 11 vs. 66 +/- 8 yea rs, P = 0.001) and tended to have higher DBP (100 +/- 8 vs. 93 +/- 11 mmHg, P = 0.065). The function of the affected kidney, or that of the more affec ted kidney if RAD was bilateral, was better preserved in responders (relati ve clearance on captopril renography 23 +/- 15 vs. 8 +/- 4%, P = 0.008). A response was more often seen in unilateral than in bilateral RAD (81% vs, 3 3%, P = 0.015). A relative clearance of less than or equal to 10% on captop ril renography had sensitivity of 88% and specificity of 81% for renal arte ry occlusion. Step-wise logistic analysis. (I) When DBP was< 95 mmHg with two antihyperte nsives, the response rate was 1/6 vs. 24/29 for more severe hypertension (P = 0.004). (2) Elderly patients had a response rate of 2/5 vs. 22/24 in you nger patients (P = 0.024). (3) Response rates in bilateral and unilateral d isease were not different, nor did the function of the affected kidney impa ct the DBP response. However, three of the four responders with less than o r equal to 10% relative clearance had an occluded renal artery and underwen t nephrectomy. nConclusions. Middle-aged patients with easily controlled hypertension and elderly hypertensives do not usually have a blood pressure response to the performed or attempted invasive treatment of RAD. Therefore, it seems recom mendable not to screen such patients for RAD, unless their renal function i s deteriorated, If the affected kidney functions poorly on captopril renogr aphy, angioplasty is usually not applicable and seldom leads to a blood pre ssure response.