Revascularization of renal artery stenosis in patients with renal insufficiency

The incidence and prevalence of end-stage renal disease (ESRD), particularl y in the elderly population, have continued to increase in the United State s. It is estimated that 10% to 20% of the elderly patients with ESRD have p otentially remediable renal vascular disease. The purpose of the present st udy is to examine the results of renal artery revascularization in 20 patie nts aged older than 55 years with chronic renal failure (serum creatinine l evel >2 mg/dL) with proximal renal artery stenosis (RAS) diagnosed by magne tic resonance angiography (MRA) who underwent surgical or percutaneous reva scularization, Patients were followed up closely in the postrevascularizati on period; renal function was monitored and potential complications of the procedure were carefully noted. Four of the 20 patients developed serious c omplications, including 3 patients with clinically significant atheroemboli c disease and 1 patient with renal artery dissection. Seven patients develo ped greater than 5% eosinophilia, Five of the 20 patients had a deteriorati on in renal function 3 to 6 months after the procedure, and only 5 patients had a reduction in serum creatinine concentration 3 to 6 months after the procedure. The present study suggests that In elderly patients with chronic renal failure and proximal RAS, revascularization of renal vessels is asso ciated with a high complication rate, and improvement in renal function occ urs in only 25% of the patients. Whether revascularization can slow the rat e of progression of renal failure remains uncertain and can only be answere d by a large prospective trial. (C) 2000 by the National Kidney Foundation, Inc.