Atherosclerotic Renal Artery Stenosis: is there still a reason for renal revascularization?

Abstract

Atherosclerotic Renal Artery Stenosis (ARAS) is a frequent problem in clinical practice. The disease is associated with three major clinical syndromes: ischemic nephropathy, hypertension and destabilizing cardiac syndromes. Although some case series showed a trend towards reduced rates of decline in renal function following renal stent placement, other studies suggested less convincing evidence of benefits. To date, randomized controlled clinical trials about optimal medical therapy versus renal artery stenting, designed to demonstrate the preservation of renal function after stenting, failed to show a benefit with respect to blood pressure and kidney function. It is still necessary to identify the subgroups that would benefit from the treatment. This review was developed to guide in the management of renal stenting and supports guidelines citing flash pulmonary edema as an indication for renal stenting in ARAS. Patients presenting a combination of rapidly declining kidney function and refractory hypertension may also benefit from revascularization and may undergo, after a careful evaluation, renal stenting. Anyhow Doppler ultrasound examination provides physiological and relevant information about viable ischemic kidney.