Renal function and atherosclerotic renovascular disease

摘要: Renovascular disease (RVD) is a potentially reversible cause of renal failure and renovascular hypertension. However, in the absence definitive clinical trials, there lack evidence regarding its optimal management. We first addressed central role function cardiovascular (CVD) part I this thesis. Renal seems to have strong relationship with atherosclerosis, generalized process which starts early life. In patients manifest vascular disease, we demonstrated that more severe decrease size age was pronounced than less atherosclerosis. also found moderate severely impaired an independent predictor future CVD. second thesis, imaging techniques artery are studied, both MRI (magnetic resonance imaging) angiography. offers means assess anatomical as well functional information about kidney, non-invasive way. measured blood flow arteries healthy volunteers MRI, but relatively small mobile arteries, measurement difficult, limited reproducibility. Until end 90s, stent placement treatment choice for atherosclerotic stenosis (ARAS). recurrent can occur stent. in-stent stenoses be treated balloon dilatation or stent, good technical success rates after year. Part III describes STAR trial, multicenter randomized trial impairment ARAS. Stent has been proved feasible technique ARAS, long term patency. superiority compared medical only terms function, lacking. 140 (creatinine clearance 50% ARAS plus artery. groups, consisted pressure lipid-lowering drugs statin. Patients were followed 2 years function. The primary point defined >20% creatinine clearance. no statistically significant difference between medication group. serious complications related procedure occurred group, mortality rate 3%. might beneficial unilateral stenosis, will need confirmed longer follow-up. balance preservation by improved adverse events following placement, not favor placement. findings conservative therapeutic approach focused on risk factor