Jornal Vascular Brasileiro
https://www.jvascbras.org/article/doi/10.1590/S1677-54492008000200003
Jornal Vascular Brasileiro
Original Article

Tratamento endovascular da estenose da artéria renal em rim único

Endovascular treatment of renal stenosis in solitary kidney

Ana Terezinha Guillaumon; Eduardo Faccini Rocha; Charles Angotti Furtado de Medeiros

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Resumo

CONTEXTO: O tratamento endovascular da doença renal hipertensiva, em doentes com rim único, conseqüente à estenose de artéria renal, mostrou ser efetivo na prevenção da falência do órgão, sua função e controle da hipertensão. Quando indicado após avaliação criteriosa, tanto bioquímica como por imagens e sinais do doente, o tratamento endovascular apresenta benefícios clínicos de forma efetiva e pouco invasiva. OBJETIVO: Estudar a doença hipertensiva renovascular e avaliar a eficácia do tratamento endovascular no controle da hipertensão arterial sistêmica e da insuficiência renal secundárias à estenose da artéria renal e como medida de prevenção de falência renal em doentes com rim único funcionante. MÉTODO: Estudo realizado com protocolo de atendimento previamente elaborado, no Centro de Referência de Alta Complexidade em Cirurgia Endovascular do Hospital de Clínicas da Universidade de Campinas, de abril de 1997 a junho de 2005, em 10 doentes com diagnóstico de estenose da artéria renal em rim único funcionante, submetidos ao tratamento endovascular. Foi avaliada a melhora da hipertensão e função renal através de seguimento clínico e laboratorial com medidas de pressão arterial, dosagens séricas de uréia, creatinina e clearance. Exames pelo eco-color-Doppler foram realizados no pós-operatório de 30 dias, 3 meses, 6 meses e anualmente; no caso de haver alguma dúvida na obtenção de imagens ou sinais, foi realizada a aortografia e arteriografia seletiva renal. Nesta casuística, 90% dos doentes apresentavam hipertensão arterial, 70% eram tabagistas, 40%, hiperlipidêmicos, 30% apresentavam doença oclusiva cerebral extracraniana, 60%, obstrução arterial crônica nos membros inferiores, e 20%, diabetes melito. RESULTADOS: O sucesso inicial foi de 100%. O seguimento médio foi de 40 meses. Houve controle da pressão arterial em 90%, diminuição significativa dos níveis de uréia e creatinina após procedimento e piora do quadro de hipertensão em 10%. CONCLUSÃO: O tratamento endovascular da estenose da artéria renal é uma técnica que apresenta benefícios clínicos no controle da hipertensão arterial, preserva a função renal e desacelera a progressão da insuficiência renal crônica de origem renovascular, porém sem melhora desta.

Palavras-chave

Hipertensão renovascular, estenose, stents

Abstract

BACKGROUND: Endovascular treatment of hypertensive renal disease in patients with a solitary kidney secondary to renal artery stenosis proved to be effective to prevent organ failure and function, as well as hypertension control. When indicated after judicious evaluation using both biochemical methods and the patient's images and signs, endovascular treatment has effective clinical benefits and is little invasive. OBJECTIVE: To study renal artery stenosis with hypertension and evaluate the effectiveness of endovascular treatment in the control of hypertension, renal failure secondary to renal artery stenosis, and in the prevention of renal failure in patients with a solitary kidney. METHODS: This study was performed at the Reference Center of High Complexity in Endovascular Surgery of Hospital de Clínicas da Universidade de Campinas from April 1997 through June 2005 using a previously developed protocol. Ten patients with renal artery stenosis and solitary kidney submitted to endovascular treatment were included. Improvement in hypertension and renal function was assessed through clinical follow-up and laboratory tests using measurements of blood pressure, serum urea levels, creatinine and clearance. Color-flow Doppler ultrasound was performed 30, 90, 180 days after the surgery and yearly thereafter. Aortography and selective renal arteriography were performed in case of doubt as to images or signs. For this population, 90% had hypertension, 70% were smokers, 40% had hyperlipidemia, 30% had carotid artery occlusive disease, 60% had chronic lower limb arterial occlusion, and 20% had diabetes mellitus. RESULTS: Immediate success was 100%. Mean follow-up time was 40 months. Control of blood pressure occurred in 90% of the cases, and in 10% there was significant reduction in urea and creatinine levels and worsening of hypertension after the procedure. CONCLUSION: Endovascular treatment of renal artery stenosis is a technique that has clinical benefits in hypertension control, preserving renal function and progression of this disease, but without improvement in renal function.

Keywords

Renovascular hypertension, stenosis, stent

References

Scoble J, Maher E, Hamilton G, Dick R, Sweny P, Moorhead JF. Atherosclerotic renovascular disease causing renal impairment: a case for treatment. Clin Nephrol. 1989;31:119-22.

Olin JW, Melia M, Young JR, Graor RA, Risius B. Prevalence of atherosclerotic renal artery stenosis in patients with atherosclerosis elsewhere. Am J Med. 1990;88:46N-51N.

Zierler RE, Bergelin RO, Isaacson JA, Strandness DE. Natural history of atherosclerotic renal stenosis: a prospective study with duplex ultrasonography. J Vasc Surg. 1994;19:250-7.

Wright JR, Shurrab AE, Cheung C. A prospective study of determinants of renal function outcome and mortality in atherosclerotic renovascular disease. Am J Kidney Dis. 2002;39:1153-61.

Suresh M, Laboi P, Mamtora H, Kalra PA. Relationship of renal dysfunction to proximal artery disease severity in atherosclerotic renovascular disease. Nephrol Dial Transplant. 2000;15:631-6.

Hunt JC, Strong CG. Renovascular hypertension: Mechanisms, natural history and treatment. Am J Cardiol. 1973;32:562-74.

Davis BA, Crook JE, Vestal RE, Oates JA. Prevalence of renovascular hypertension in patients with grade III or IV hypertensive retinopathy. N Engl J Med. 1979;301:1273-6.

Axelrod DA, Fendrick AM, Carlos RC. Percutaneous stenting of incidental unilateral renal artery stenosis: decision analysis of cost costs and benefits. J Endovasc Ther. 2003;10:546-56.

Ayerdi J, Hodgson KJ. Ballon angioplasty and stenting for renovascular occlusive disease. Persp Vasc Surg Endovasc Ther. 2004;16:25-38.

Sahin S, Cimsit C, Andaç N, Baltacioglu F, Tuglular S, Akoglu E. Renal artery stenting in solitary functioning kidneys: technical and clinical results. Eur J Radiol. 2006;57:131-7.

Shannon HM, Gillespie IN, Moss JG. Salvage of the solitary kidney by insertion of a renal artery stent. AJR Am J Roentgenol. 1998;171:217-22.

Cioni R, Vignali C, Petruzzi P. Renal stenting in patients with a solitary functioning kidney. Cardiovasc Intervent Radiol. 2001;24:372-7.

Gruntzig A, Kuhlmann U, Vetterr W, Lütolf U, Meier B, Siegenthaler W. Treatment of renovascular hypertension with percutaneous transluminal dilatation of a renal artery stenosis. Lancet. 1978;1:801-2.

Scolari F, Ravani P, Pola A. Predictors of renal and patient outcomes in atheroembolic renal disease: a prospective study. J Am Soc Nephrol. 2003;14:1584-90.

Mukherjee D, Bhatt DL, Robbins M. Renal artery end-diastolic velocity and renal artery resistance index as predictors of outcome after renal stenting. Am J Cardiol. 2001;88:1064-6.

Chatziiannou A, Mourikis D, Agroyannis B. Renal artery stenting for renal insufficiency in solitary kidney in 26 patients. Eur J Vasc Endovasc Surg. 2002;23:49-54.

Sivamurthy N, Surowiec SM, Culakova E. Divergent outcomes after percutaneous therapy for symptomatic renal artery stenosis. J Vasc Surg. 2004;39:565-74.

Beutler JJ, Van Ampting JM, Van De Ven PJ. Long-term effects of arterial stenting on kidney function for patients with ostial atherosclerotic renal artery stenosis and renal nsufficiency. J Am Soc Nephrol. 2001;12:1475-81.

Pillay WR, Kan YM, Crinnion JN, Wolfe JH. Prospective multicentre study of the natural history of atherosclerotic renal artery stenosis in patients with peripheral vascular disease. Br J Surg. 2002;89:737-40.

Cherr GS, Hansen KJ, Craven TE. Surgical management of atherosclerotic renovascular disease. J Vasc Surg. 2002;35:236-45.

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