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The effect of revascularization of renal artery stenosis on renal perfusion in patients with atherosclerotic renovascular disease

Niina Koivuviita, Kaisa Liukko, Nobu Kudomi, Vesa Oikonen, Risto Tertti, Ilkka Manner, Tero Vahlberg, Pirjo Nuutila, Kaj Metsärinne
Nephrology, Dialysis, Transplantation 2012, 27 (10): 3843-8

BACKGROUND: Only a small fraction of patients with atherosclerotic renovascular disease (ARVD) treated with revascularization have improved renal function after the procedure. It has been suggested that this may be due to effects of renal microvascular disease. Our aim was to measure the effect of renal artery stenosis (RAS) revascularization on renal perfusion in patients with renovascular disease.

METHODS: Seventeen renovascular disease patients were treated by dilatation of unilateral (N = 8) or bilateral (N = 9) RAS (N = 23 kidneys), mainly because of uncontrolled or refractory hypertension. The patients were studied before and after (103 ± 29 days) the procedure. Renal perfusion was measured using quantitative positron emission tomography (PET) perfusion imaging.

RESULTS: Although renal perfusion correlated inversely with the degree of RAS in patients with renovascular disease, it did not change after revascularization.

CONCLUSIONS: Our data support the notion of former clinical trials that angiographic severity of RAS does not determine the response to revascularization. Quantitative PET perfusion imaging is a promising tool to noninvasively measure renal perfusion for the assessment of physiological impact of RAS.

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