Characteristics of successful PTRA cases with severely impaired kidney function caused by bilateral atherosclerotic stenosis: A case series.

Abstract

Previous randomized controlled trials have not demonstrated the benefits of renal artery stenting with respect to kidney function. However, these trials did not focus on patients with severely impaired kidney function caused by severe bilateral stenosis. Therefore, the efficacy of stenting in such patients remains unclear. We report four cases of successful PTRA with severely impaired kidney function with rapid decline caused by bilateral atherosclerotic stenosis. The catheterization before irreversible parenchymal damages was useful in improving kidney function dramatically in these cases of severe bilateral renal artery stenosis. Furthermore, we examined the clinical characteristics of the four cases to identify the potential predictors of PTRA effectiveness. Notably, bilateral renal artery >90% stenosis, elevated plasma renin activity, eGFR <15 mL/min/1.73 m2 with an accelerated decline within 6 months before PTRA (> 50 mL/min/1.73 m2/6 months), and resistance index (RI) <0.7 were identified as common findings. PTRA should be considered a treatment strategy for patients with these features to preserve kidney function and avoid dialysis therapy.