Techniques for predicting a favourable response to renal angioplasty in patients with renovascular disease

Renovascular disease is present in some 10-40% of patients with end-stage r enal disease, and constitutes the fastest-growing group of end-stage renal disease patients. The unselective correction of renal artery stenosis has l ed to disappointing results. Most studies that compared conservative treatm ent with angioplasty found only modest or no beneficial effects of angiopla sty on renal function and blood pressure. It is therefore mandatory to eval uate the functional significance of a stenosis before intervention. Patient s with a high likelihood of a favourable response should be identified. Fac tors that affect outcome include the severity of renal artery stenosis, the procedure used to treat renal artery stenosis (antihypertensive drugs, ang ioplasty with or without stenting, or surgery), radiocontrast nephrotoxicit y, atheroembolism and, most importantly, underlying renal disease, forestal ling a favourable response of renal function or blood pressure even after t he successful correction of renal artery stenosis. Evaluation of the renal resistance index using Doppler ultrasound or captopril scintigraphy are the best methods by which to classify patients as responders or non-responders to intervention. Each factor has to be considered before the correction of renal artery stenosis to achieve satisfactory results with regard to an im provement in renal function and blood pressure. Curr Opin Nephrol Hypertens 10:799-805. (C) 2001 Lippincott Williams & Wilkins.