3 R study: renal outcome in renal ischemia: revascularisation or medical treatment

Ischemic nephropathy refers to the kidney damage following stenosis or an o bstructive lesion in the main kidney arteries. This disorder has been overl ooked in the past and a more rational and specific use of clinical criteria , and the development of not very invasive techniques with a good diagnosti c accuracy such as spiral CT angiography, NMR angiography and echo-colour-D oppler have improved our ability to identify these patients. It is therefor e likely that, in the next few years, we will find ourselves treating an in creasing number of patients with renovascular ischemic disorders. Transluminal angioplasty and, more recently, the use of endovascular stents , have led to a marked improvement in the treatment of stenoses and, togeth er with vascular surgery, allow to treat almost all patients with this diso rder. There is, however, a lack of prospective and controlled studies, whic h demonstrate the long term benefit of revascularization treatment, as comp ared with optimum conservative treatment in reducing cardiovascular mortali ty, cardiovascular events and preserving renal function. The Ischemic Nephropathy Study Group of the Italian Society of Nephrology h as organized a prospective, controlled study over a period of three years, aimed at comparing the effect of revascularization versus medical therapy i n 300 patients with renal artery stenosis, ranging between 50 and 90 per ce nt, who will be randomly assigned to the two treatments. End point will be cardiovascular mortality and morbidity and need for renal replacement thera py.