Abstract:

Atherosclerotic renal artery stenosis (ARAS) is the most common cause of renal artery stenosis now, which not only causes hypertension, but also ischemic renal disease. Surgical revascularization is associated with significant perioperative morbidity and mortality and is no longer preferred after the 90 era. Percutaneous transluminal renal angioplasty with stent implantation has become the predominant intervention for ARAS since then. There are several randomized trials comparing medical management with angioplasty or renal artery (RA) stenting. It showed that angioplasty was not superior to medical therapy in blood pressure control, but had a significant drug-saving effect. Two large recent trials showed that RA stenting had no benefit over medical therapy in outcomes of blood pressure, renal function preservation, and mortality. Moreover, in the angioplasty and stenting for renal artery lesions(ASTRAL) trial that included 804 patients, a subgroup analysis was done based on baseline glomerular filtration rate (GFR), degree of stenosis, and renal size, and no difference in outcome was found between the groups. Studies showed that statins had protective effects on kidney beyond lowering lipidemia. Recent nonrandomized trials in ARAS showed that renin angiotensin aldosterone system (RAAS) blockade offers significant benefit in terms of renal function preservation, as well as survival. Agents that block the RAAS improve outcomes and should be a part of the medical regimen in ARAS. Concern of acute kidney injury in ARAS with impaired GFR has been a barrier to the use of these agents, but it can be easily detected early and reversed by discontinuing or adjusting the dose of the drug.

Key words: Ischemic renal disease, Atherosclerosis, Renal artery stenosis, Interventional therapy, Drug therapy