Medicine › Pulmonary and Respiratory Medicine

Renal and Vascular Pathologies

Works Count: 61071

Wikipedia

Description

This cluster of papers focuses on the diagnosis and treatment of renal artery stenosis, including topics such as fibromuscular dysplasia, renovascular hypertension, renal function, stent placement, doppler ultrasonography, atherosclerotic renovascular disease, renal transplantation, oxidative stress, and angioplasty.

Keywords

Renal Artery Stenosis; Fibromuscular Dysplasia; Renovascular Hypertension; Renal Function; Stent Placement; Doppler Ultrasonography; Atherosclerotic Renovascular Disease; Renal Transplantation; Oxidative Stress; Angioplasty

Revascularization versus Medical Therapy for Renal-Artery Stenosis

2009-11-11

K Wheatley , Natalie Ives , Richard Gray +7 more

Percutaneous revascularization of the renal arteries improves patency in atherosclerotic renovascular disease, yet evidence of a clinical benefit is limited.In a randomized, unblinded trial, we assigned 806 patients with atherosclerotic … Percutaneous revascularization of the renal arteries improves patency in atherosclerotic renovascular disease, yet evidence of a clinical benefit is limited.In a randomized, unblinded trial, we assigned 806 patients with atherosclerotic renovascular disease either to undergo revascularization in addition to receiving medical therapy or to receive medical therapy alone. The primary outcome was renal function, as measured by the reciprocal of the serum creatinine level (a measure that has a linear relationship with creatinine clearance). Secondary outcomes were blood pressure, the time to renal and major cardiovascular events, and mortality. The median follow-up was 34 months.During a 5-year period, the rate of progression of renal impairment (as shown by the slope of the reciprocal of the serum creatinine level) was -0.07x10(-3) liters per micromole per year in the revascularization group, as compared with -0.13x10(-3) liters per micromole per year in the medical-therapy group, a difference favoring revascularization of 0.06x10(-3) liters per micromole per year (95% confidence interval [CI], -0.002 to 0.13; P=0.06). Over the same time, the mean serum creatinine level was 1.6 micromol per liter (95% CI, -8.4 to 5.2 [0.02 mg per deciliter; 95% CI, -0.10 to 0.06]) lower in the revascularization group than in the medical-therapy group. There was no significant between-group difference in systolic blood pressure; the decrease in diastolic blood pressure was smaller in the revascularization group than in the medical-therapy group. The two study groups had similar rates of renal events (hazard ratio in the revascularization group, 0.97; 95% CI, 0.67 to 1.40; P=0.88), major cardiovascular events (hazard ratio, 0.94; 95% CI, 0.75 to 1.19; P=0.61), and death (hazard ratio, 0.90; 95% CI, 0.69 to 1.18; P=0.46). Serious complications associated with revascularization occurred in 23 patients, including 2 deaths and 3 amputations of toes or limbs.We found substantial risks but no evidence of a worthwhile clinical benefit from revascularization in patients with atherosclerotic renovascular disease. (Current Controlled Trials number, ISRCTN59586944.)

View PDF Chat

Renal artery stenosis

1992-05-01

Michael B. Harding , Lloyd R. Smith , Stevan I. Himmelstein +6 more

The purposes of this study were to determine the prevalence of angiographically significant renal artery stenosis in a patient population referred for diagnostic cardiac catheterization and to develop a model … The purposes of this study were to determine the prevalence of angiographically significant renal artery stenosis in a patient population referred for diagnostic cardiac catheterization and to develop a model that predicts the highest-risk subset of patients who have significant renal artery narrowing. A prospective validation cohort study was undertaken in a referral-based university hospital. After left ventriculography, abdominal aortography was performed to screen for the presence of renal artery disease. A convenience sample of 1,302 of 1,651 consecutive patients undergoing diagnostic cardiac catheterization were enrolled in the study. Of the 1,302 abdominal aortograms performed, 1,235 (95%) were deemed of adequate quality for the evaluation of renal artery anatomy. Renal artery disease was identified in 30% of the patients. Insignificant renal artery stenosis was found in 187 (15%) and significant (greater than or equal to 50% diameter narrowing) stenosis was found in 188 (15%). Significant unilateral disease was present in 11%, and bilateral disease was present in 4%. By univariable and multivariable logistic regression analysis, the association of both clinically and catheterization-derived variables with renal artery disease was assessed. Multivariable predictors included age, severity of coronary artery disease, congestive heart failure, female gender, and peripheral vascular disease. Hypertension was not an associated variable. These data reveal the previously undetected high prevalence of renal artery disease in patients undergoing cardiac catheterization and provide clinical and angiographic features that assist in predicting its presence.

Prospective Study of Atherosclerotic Disease Progression in the Renal Artery

1998-12-22

T. Michael , Claudio Perissinotto , R. Eugene Zierler +6 more

Background —The aim of this study was to determine the incidence of and the risk factors associated with progression of renal artery disease in individuals with atherosclerotic renal artery stenosis … Background —The aim of this study was to determine the incidence of and the risk factors associated with progression of renal artery disease in individuals with atherosclerotic renal artery stenosis (ARAS). Methods and Results —Subjects with ≥1 ARAS were monitored with serial renal artery duplex scans. A total of 295 kidneys in 170 patients were monitored for a mean of 33 months. Overall, the cumulative incidence of ARAS progression was 35% at 3 years and 51% at 5 years. The 3-year cumulative incidence of renal artery disease progression stratified by baseline disease classification was 18%, 28%, and 49% for renal arteries initially classified as normal, <60% stenosis, and ≥60% stenosis, respectively ( P =0.03, log-rank test). There were only 9 renal artery occlusions during the study, all of which occurred in renal arteries having ≥60% stenosis at the examination before the detection of occlusion. A stepwise Cox proportional hazards model included 4 baseline factors that were significantly associated with the risk of renal artery disease progression during follow-up: systolic blood pressure ≥160 mm Hg (relative risk [RR]=2.1; 95% CI, 1.2 to 3.5), diabetes mellitus (RR=2.0; 95% CI, 1.2 to 3.3), and high-grade (>60% stenosis or occlusion) disease in either the ipsilateral (RR=1.9; 95% CI, 1.2 to 3.0) or contralateral (RR=1.7; 95% CI, 1.0 to 2.8) renal artery. Conclusions —Although renal artery disease progression is a frequent occurrence, progression to total renal artery occlusion is not. The risk of renal artery disease progression is highest among individuals with preexisting high-grade stenosis in either renal artery, elevated systolic blood pressure, and diabetes mellitus.

View PDF Chat

The Utility of Duplex Ultrasound Scanning of the Renal Arteries for Diagnosing Significant Renal Artery Stenosis

1995-06-01

Jeffrey W. Olin

Objective: To determine the utility of duplex ultrasound scanning of the renal arteries in identifying patients with renal artery stenosis of 60% or more and in excluding patients with either … Objective: To determine the utility of duplex ultrasound scanning of the renal arteries in identifying patients with renal artery stenosis of 60% or more and in excluding patients with either normal renal arteries or renal artery stenosis of less than 60%. Design: A prospective, blinded study. Setting: Large tertiary referral center. Patients: 102 consecutive patients (44 men and 58 women with a mean age [±SD] of 63.3 ±13.4 years) who had both duplex ultrasound scanning of the renal arteries and renal arteriography. All patients who were studied had hypertension that was difficult to control, unexplained azotemia, or associated peripheral vascular disease (alone or in combination), giving them a high pretest likelihood of renovascular disease. Main Outcome Measurements: Peak systolic and end diastolic velocities, renal-aortic ratios, resistive index, and kidney sizes. Results: Sixty-two of 63 arteries with stenosis of less than 60% using arteriography were correctly identified by duplex ultrasound scanning. Thirty-one of 32 arteries with 60% to 79% stenosis using arteriography were correctly identified as having 60% to 99% stenosis on duplex ultrasound, whereas 67 of 69 arteries with 80% to 99% stenosis on arteriography were correctly identified as having 60% to 99% stenosis on ultrasound. Twenty-two of 23 arteries with total occlusion on arteriography were correctly identified by duplex ultrasound. The overall sensitivity of duplex ultrasound compared with arteriography was 0.98, the specificity was 0.98, the positive predictive value was 0.99, and the negative predictive value was 0.97. Conclusion: Duplex ultrasound scanning of the renal arteries is an ideal screening test because it is noninvasive and can predict the presence or absence of renal artery stenosis with a high degree of accuracy.

TREATMENT OF RENOVASCULAR HYPERTENSION WITH PERCUTANEOUS TRANSLUMINAL DILATATION OF A RENAL-ARTERY STENOSIS

1978-04-01

A Grüntzig , W. Vetter , Bernhard Meier +3 more

Renal-Artery Stenosis

2001-02-08

Robert D. Safian , Stephen C. Textor

Primary diseases of the renal arteries often involve the large renal arteries, whereas secondary diseases are frequently characterized by small-vessel and intrarenal vascular disease. In this article, we will concentrate … Primary diseases of the renal arteries often involve the large renal arteries, whereas secondary diseases are frequently characterized by small-vessel and intrarenal vascular disease. In this article, we will concentrate on the two most common primary diseases of the renal arteries — atherosclerotic renal-artery stenosis and fibromuscular dysplasia — and their association with two common clinical syndromes, hypertension and ischemic nephropathy. The relations among renal-artery stenosis, hypertension, and renal excretory dysfunction are complex (Figure 1). Renal-artery stenosis may occur alone (isolated anatomical renal-artery stenosis) or in association with hypertension, renal insufficiency (ischemic nephropathy), or both.Prevalence and Natural HistoryFibromuscular . . .

Percutaneous Transluminal Renal Angioplasty in Renovascular Hypertension Due to Atheroma or Fibromuscular Dysplasia

1983-08-04

Thomas A. Sos , Thomas G. Pickering , Kenneth W. Sniderman +5 more

We attempted percutaneous transluminal renal angioplasty in 89 patients with hypertension and renal-artery stenosis (including 51 with atheromatous and 31 with fibromuscular stenoses) who were then followed for an average … We attempted percutaneous transluminal renal angioplasty in 89 patients with hypertension and renal-artery stenosis (including 51 with atheromatous and 31 with fibromuscular stenoses) who were then followed for an average of 16 months (range, 4 to 40). Angioplasty was technically successful in 87 per cent of the fibromuscular stenoses and in 57 per cent of the unilateral atheromatous stenoses but in only 10 per cent of the bilateral atheromatous stenoses. After successful angioplasty, blood pressure was reduced to normal or improved in 93 per cent of the patients with fibromuscular dysplasia and in 84 per cent of the patients with atheromatous disease. Angiographic follow-up at an average of 21.8 months in 15 patients showed persistent relief of the stenoses and a 12 per cent average increase in kidney size. Renal angioplasty is effective for long-term control of hypertension in patients with renal-artery stenosis due to fibromuscular dysplasia or unilateral non-ostial atheroma.

Arteriographic complications in the DSA era.

1992-01-01

John Waugh , NINA SACHARIAS

Prospective data were collected on complications associated with intraarterial digital subtraction angiography in 2,475 consecutive patients at a 650-bed Melbourne teaching hospital. Carotid or cerebral studies were performed in 939 … Prospective data were collected on complications associated with intraarterial digital subtraction angiography in 2,475 consecutive patients at a 650-bed Melbourne teaching hospital. Carotid or cerebral studies were performed in 939 patients, and the prevalence of stroke (ie, permanent neurologic deficit) was 0.3%. The overall prevalence of systemic complications was 1.8%, with no patients requiring hemodialysis because of renal failure. Comparison was made with previously reported complication rates for conventional film angiography.

Prevalence of renovascular disease in the elderly: A population-based study

2002-09-01

Kimberley J. Hansen , Matthew S. Edwards , Timothy E. Craven +5 more

Atherosclerotic Renovascular Disease and Progressive Renal Failure

1993-05-01

Jeffrey M. Rimmer

Purpose: To evaluate information on the prevalence and rate of progression of atherosclerotic renovascular disease and the effect of angiotensin-converting enzyme inhibition on this process, with the goal of developing … Purpose: To evaluate information on the prevalence and rate of progression of atherosclerotic renovascular disease and the effect of angiotensin-converting enzyme inhibition on this process, with the goal of developing a rational approach to the diagnosis and management of this disorder. Data Sources: Relevant articles were identified from the authors' files and from MEDLINE searches. Additional references were obtained from the bibliographies of identified articles. Study Selection: Virtually no controlled prospective studies have been reported. The articles presented are primarily retrospective analyses and include those that provide sufficient information about the incidence or progression of renovascular disease and about the outcome and mortality rate associated with various treatments, to allow evaluation. Data Extraction: For the outcomes of interest, data from individual reports are presented in tabular form, the results summed, and averages obtained. Results: Atherosclerotic renovascular disease, in many cases involving both renal arteries, is a common finding in patients older than 50 years, particularly those with diffuse atherosclerotic vascular disease. Hypertension is not a particularly sensitive indicator of this disease (almost one half are not hypertensive). The disease progresses and may account for 5% to 15% of all patients developing end-stage renal disease each year. Angiotensin-converting enzyme inhibition may damage ischemic renal tissue, but this is counterbalanced by beneficial effects of this therapy. Once end-stage renal disease is present, mortality rates are high despite dialysis support (> 50% over 3 years). Both surgery and angioplasty can preserve or improve renal function and may delay or prevent the need for dialysis therapy. These invasive procedures may have lower rates of morbidity and mortality than the so-called conservative approach of dialysis therapy when renal failure develops. Conclusions: Given available information, diagnosis and intervention should be considered seriously in patients at high risk for renovascular disease who have clearly progressing renal insufficiency. Prospective trials are needed, however, to determine the costs and benefits of each approach to treatment in all patients with renovascular disease and renal insufficiency.

The Renal Arterial Resistance Index and Renal Allograft Survival

2003-07-09

Jörg Radermacher , Michael Mengel , S. Ellis +7 more

Most renal transplants fail because of chronic allograft nephropathy or because the recipient dies, but no reliable factor predicting long-term outcome has been identified. We tested whether a renal arterial … Most renal transplants fail because of chronic allograft nephropathy or because the recipient dies, but no reliable factor predicting long-term outcome has been identified. We tested whether a renal arterial resistance index of less than 80 was predictive of long-term allograft survival.The renal segmental arterial resistance index (the percentage reduction of the end-diastolic flow as compared with the systolic flow) was measured by Doppler ultrasonography in 601 patients at least three months after transplantation between August 1997 and November 1998. All patients were followed for three or more years. The combined end point was a decrease of 50 percent or more in the creatinine clearance rate, allograft failure (indicated by the need for dialysis), or death.A total of 122 patients (20 percent) had a resistance index of 80 or higher. Eighty-four of these patients (69 percent) had a decrease of 50 percent or more in creatinine clearance, as compared with 56 of the 479 patients with a resistance index of less than 80 (12 percent); 57 patients with a higher resistance index (47 percent) required dialysis, as compared with 43 patients with a lower resistance index (9 percent); and 36 patients with a higher resistance index (30 percent) died, as compared with 33 patients with a lower resistance index (7 percent) (P<0.001 for all comparisons). A total of 107 patients with a higher resistance index (88 percent) reached the combined end point, as compared with 83 of those with a lower resistance index (17 percent, P<0.001). The multivariate relative risk of graft loss among patients with a higher resistance index was 9.1 (95 percent confidence interval, 6.6 to 12.7). Proteinuria (protein excretion, 1 g per day or more), symptomatic cytomegalovirus infection, and a creatinine clearance rate of less than 30 ml per minute per 1.73 m2 of body-surface area after transplantation also increased the risk.A renal arterial resistance index of 80 or higher measured at least three months after transplantation is associated with poor subsequent allograft performance and death.

View PDF Chat

The Effect of Balloon Angioplasty on Hypertension in Atherosclerotic Renal-Artery Stenosis

2000-04-06

Brigit C. van Jaarsveld , Pieta Krijnen , H. Pieterman +7 more

Patients with hypertension and renal-artery stenosis are often treated with percutaneous transluminal renal angioplasty. However, the long-term effects of this procedure on blood pressure are not well understood. Patients with hypertension and renal-artery stenosis are often treated with percutaneous transluminal renal angioplasty. However, the long-term effects of this procedure on blood pressure are not well understood.

View PDF Chat

Fibromuscular Dysplasia: State of the Science and Critical Unanswered Questions

2014-02-19

Jeffrey W. Olin , Heather L. Gornik , J. Michael Bacharach +7 more

The American Heart Association makes every effort to avoid any actual or potential The American Heart Association makes every effort to avoid any actual or potential

Surgical Correction of Transposition of the Great Vessels

1963-08-01

Elmore M. Aronstam , Thomas H. Hewlett , James A. Orbison +2 more

Aronstam, Elmore M. MC, U.S.A.; Hewlett, Thomas H. MC, U.S.A.; Orbison, James A. MC, U.S.A.; Franklin, Robert B. MC, U.S.A.; Dixon, Leon M. MC, U.S.A. Author Information Aronstam, Elmore M. MC, U.S.A.; Hewlett, Thomas H. MC, U.S.A.; Orbison, James A. MC, U.S.A.; Franklin, Robert B. MC, U.S.A.; Dixon, Leon M. MC, U.S.A. Author Information

Diagnostic Tests for Renal Artery Stenosis in Patients Suspected of Having Renovascular Hypertension

2001-09-18

G. Boudewijn C. Vasbinder , Patricia J. Nelemans , Alfons G.H. Kessels +3 more

Purpose: To summarize and compare the validity of computed tomography angiography, magnetic resonance angiography, ultrasonography, captopril renal scintigraphy, and the captopril test for diagnosis of renal artery stenosis in patients … Purpose: To summarize and compare the validity of computed tomography angiography, magnetic resonance angiography, ultrasonography, captopril renal scintigraphy, and the captopril test for diagnosis of renal artery stenosis in patients suspected of having renovascular hypertension. Data Sources: For each diagnostic modality, published studies were identified by MEDLINE literature searches. Study Selection: Original studies were selected if they met the following criteria: 1) suspicion of renovascular hypertension was the indication for the test; 2) intra-arterial x-ray angiography was used as the gold standard; 3) a cutoff point for a positive test result was explicitly defined; and 4) absolute numbers of true-positive, false-negative, true-negative, and false-positive results were available or could be derived from the presented data. Data Extraction: A standard form was used to extract relevant data. Data Synthesis: Data on the accuracy of the different diagnostic methods were analyzed and compared by constructing summary receiver-operating characteristic (ROC) curves and by computing areas under the summary ROC curves. Results: Although accuracy varied greatly for all diagnostic modalities, summary ROC curves found that computed tomography angiography and gadolinium-enhanced, three-dimensional magnetic resonance angiography performed significantly better than the other diagnostic tests. Conclusions: Computed tomography angiography and gadolinium-enhanced three-dimensional magnetic resonance angiography seem to be preferred in patients referred for evaluation of renovascular hypertension. However, because few studies of these tests have been published, further research is recommended.

Endothelial Function and Oxidative Stress in Renovascular Hypertension

2002-06-20

Yukihito Higashi , Shota Sasaki , Keigo Nakagawa +3 more

It has been reported that renovascular hypertension activates the renin–angiotensin system, leading to an increase in oxidative stress. We sought to determine whether renal-artery angioplasty improves endothelial dysfunction in patients … It has been reported that renovascular hypertension activates the renin–angiotensin system, leading to an increase in oxidative stress. We sought to determine whether renal-artery angioplasty improves endothelial dysfunction in patients with renovascular hypertension through a reduction in oxidative stress.

View PDF Chat

Randomised comparison of percutaneous angioplasty vs continued medical therapy for hypertensive patients with atheromatous renal artery stenosis

1998-05-01

J Webster , Freda Marshall , Marwah Abdalla +7 more

Renal ischemia: A new perspective

1984-10-01

Mayer Brezis , Seymour Rosen , Patricio Silva +1 more

Patterns of renal injury in NIDDM patients with microalbuminuria

1996-11-21

Paola Fioretto , Michael Mauer , Enrico Brocco +7 more

View PDF Chat

Ureteral obstruction as a model of renal interstitial fibrosis and obstructive nephropathy

2009-04-01

Robert L. Chevalier , Michael S. Forbes , Barbara A. Thornhill

View PDF Chat

Renal Vascular Disease Causing End-Stage Renal Disease, Incidence, Clinical Correlates, and Outcomes: A 20-Year Clinical Experience

1994-10-01

Lionel U. Mailloux , Barbara Napolitano , Alessandro Bellucci +3 more

In the United States, the incidence of end-stage renal disease to hypertension has increased sharply over the last 8 years, especially in elderly white dialysis patients who demonstrate very poor … In the United States, the incidence of end-stage renal disease to hypertension has increased sharply over the last 8 years, especially in elderly white dialysis patients who demonstrate very poor survival rates. The 5-year survival rates were near 20% for patients 65 to 74 years old and 9% for those > or = 75 years of age. Our program experienced a sharp increase in cases of end-stage renal disease due to renal vascular disease after 1982. Renal vascular disease was characterized clinically in 83 of 683 dialysis patients either by angiography or asymmetric kidney size in patients with evidence of systemic atherosclerosis, hypertension, insignificant proteinuria, and a benign urinary sediment. The median age was 70 years, with 84% of the patients being older than 61 years. These patients had 56% 2-year, 18% 5-year, and 5% 10-year survival rates, which are quite similar to the 1992 US Renal Data System data. Patients with renal vascular disease have a significantly worse prognosis than other diagnostic groups, most likely due to their older age, underlying vascular disease, and coronary artery disease. We feel that a significant number of elderly white hypertensive patients described in the 1992 US Renal Data Service report have renal vascular disease as a cause of end-stage renal disease, highlighting the need to establish correct renal diagnoses. Hypertension should not be the end-stage renal disease diagnosis in elderly white hypertensive patients if clinical criteria suggest a diagnosis of renal vascular disease.

Stent Placement in Patients With Atherosclerotic Renal Artery Stenosis and Impaired Renal Function

2009-06-16

L. Bax , Arend‐Jan Woittiez , Hans J. Kouwenberg +7 more

Background: Little is known about the efficacy and safety of renal artery stenting in patients with atherosclerotic renal artery stenosis (ARAS) and impaired renal function. Objective: To determine the efficacy … Background: Little is known about the efficacy and safety of renal artery stenting in patients with atherosclerotic renal artery stenosis (ARAS) and impaired renal function. Objective: To determine the efficacy and safety of stent placement in patients with ARAS and impaired renal function. Design: Randomized clinical trial. Randomization was centralized and computer generated, and allocation was assigned by e-mail. Patients, providers, and persons who assessed outcomes were not blinded to treatment assignment. Setting: 10 European medical centers. Participants: 140 patients with creatinine clearance less than 80 mL/min per 1.73 m2 and ARAS of 50% or greater. Intervention: Stent placement and medical treatment (64 patients) or medical treatment only (76 patients). Medical treatment consisted of antihypertensive treatment, a statin, and aspirin. Measurements: The primary end point was a 20% or greater decrease in creatinine clearance. Secondary end points included safety and cardiovascular morbidity and mortality. Results: Forty-six of 64 patients assigned to stent placement had the procedure. Ten of the 64 patients (16%) in the stent placement group and 16 patients (22%) in the medication group reached the primary end point (hazard ratio, 0.73 [95% CI, 0.33 to 1.61]). Serious complications occurred in the stent group, including 2 procedure-related deaths (3%), 1 late death secondary to an infected hematoma, and 1 patient who required dialysis secondary to cholesterol embolism. The groups did not differ for other secondary end points. Limitation: Many patients were falsely identified as having renal artery stenosis greater than 50% by noninvasive imaging and did not ultimately require stenting. Conclusion: Stent placement with medical treatment had no clear effect on progression of impaired renal function but led to a small number of significant procedure-related complications. The study findings favor a conservative approach to patients with ARAS, focused on cardiovascular risk factor management and avoiding stenting. Primary Funding Source: Dutch Kidney Foundation, Bayer, Cordis, and Pfizer.

View PDF Chat

Atherosclerotic Renal Artery Stenosis

2002-11-01

Carmine Zoccali , Francesca Mallamaci , Pietro Finocchiaro

ABSTRACT. Atherosclerotic renal artery stenosis is the most common primary disease of the renal arteries, and it is associated with two major clinical syndromes, ischemic renal disease and hypertension. The … ABSTRACT. Atherosclerotic renal artery stenosis is the most common primary disease of the renal arteries, and it is associated with two major clinical syndromes, ischemic renal disease and hypertension. The prevalence of this disease in the population is undefined because there is no simple and reliable test that can be applied on a large scale. Renal artery involvement in patients with coronary heart disease and/or heart failure is frequent, and it may influence cardiovascular outcomes and survival in these patients. Suspecting renal arterial stenosis in patients with recurrent episodes of pulmonary edema is justified by observations showing that about one third of elderly patients with heart failure display atherosclerotic renal disease. Whether interventions aimed at restoring arterial patency may reduce the high mortality in patients with heart failure is still unclear because, to date, no prospective study has been carried out in these patients. Increased awareness of the need for cost containment has renewed the interest in clinical cues for suspecting renovascular hypertension. In this regard, the DRASTIC study constitutes an important attempt at validating clinical prediction rules. In this study, a clinical rule was derived that predicted renal artery stenosis as efficiently as renal scintigraphy (sensitivity: clinical rule, 65% versus scintigraphy, 72%; specificity: 87% versus 92%). When tested in a systematic and quantitative manner, clinical findings can perform as accurately as more complex tests in the detection of renal artery stenosis. E-mail: [email protected]

View PDF Chat

Assessing the Impact of Ischaemia Time During Partial Nephrectomy

2009-07-29

Frank Becker , Hendrik Van Poppel , Oliver W. Hakenberg +6 more

The United States Registry for Fibromuscular Dysplasia

2012-05-22

Jeffrey W. Olin , James B. Froehlich , Xiaokui Gu +7 more

Fibromuscular dysplasia (FMD), a noninflammatory disease of medium-size arteries, may lead to stenosis, occlusion, dissection, and/or aneurysm. There has been little progress in understanding the epidemiology, pathogenesis, and outcomes since … Fibromuscular dysplasia (FMD), a noninflammatory disease of medium-size arteries, may lead to stenosis, occlusion, dissection, and/or aneurysm. There has been little progress in understanding the epidemiology, pathogenesis, and outcomes since its first description in 1938.Clinical features, presenting symptoms, and vascular events are reviewed for the first 447 patients enrolled in a national FMD registry from 9 US sites. Vascular beds were imaged selectively based on clinical presentation and local practice. The majority of patients were female (91%) with a mean age at diagnosis of 51.9 (SD 13.4 years; range, 5-83 years). Hypertension, headache, and pulsatile tinnitus were the most common presenting symptoms of the disease. Self-reported family history of stroke (53.5%), aneurysm (23.5%), and sudden death (19.8%) were common, but FMD in first- or second-degree relatives was reported only in 7.3%. FMD was identified in the renal artery in 294 patients, extracranial carotid arteries in 251 patients, and vertebral arteries in 82 patients. A past or presenting history of vascular events were common: 19.2% of patients had a transient ischemic attack or stroke, 19.7% had experienced arterial dissection(s), and 17% of patients had an aneurysm(s). The most frequent indications for therapy were hypertension, aneurysm, and dissection.In this registry, FMD occurred primarily in middle-aged women, although it presents across the lifespan. Cerebrovascular FMD occurred as frequently as renal FMD. Although a significant proportion of FMD patients may present with a serious vascular event, many present with nonspecific symptoms and a subsequent delay in diagnosis.

Blood Pressure Outcome of Angioplasty in Atherosclerotic Renal Artery Stenosis

1998-03-01

Pierre‐François Plouin , Gilles Châtellier , Bernadette Darné +1 more

Abstract —Data for the effects on blood pressure of renal artery balloon angioplasty are mostly from uncontrolled studies. The aim of this study was to document the efficacy and safety … Abstract —Data for the effects on blood pressure of renal artery balloon angioplasty are mostly from uncontrolled studies. The aim of this study was to document the efficacy and safety of angioplasty for lowering blood pressure in patients with atherosclerotic renal artery stenosis. Patients were randomly assigned antihypertensive drug treatment (control group, n=26) or angioplasty (n=23). Twenty-four-hour ambulatory blood pressure, the primary end point, was measured at baseline and at termination. Termination took place 6 months after randomization or earlier in patients who developed refractory hypertension. In those allocated angioplasty, antihypertensive treatment was discontinued after the procedure but was subsequently resumed if hypertension persisted. Secondary end points were the treatment score and the incidence of complications. Two patients in the control group and 6 in the angioplasty group suffered procedural complications (relative risk, 3.4; 95% confidence interval, 0.8 to 15.1). Early termination was required for refractory hypertension in 7 patients in the control group. Antihypertensive treatment was resumed in 17 patients in the angioplasty group. Mean ambulatory blood pressure at termination did not differ between control (141±15/84±11 mm Hg) and angioplasty (140±15/81±9 mm Hg) groups. Angioplasty reduced by 60% the probability of having a treatment score of 2 or more at termination (relative risk, 0.4; 95% confidence interval, 0.2 to 0.7). There was 1 case of dissection with segmental renal infarction and 3 of restenosis in the angioplasty group. No patient suffered renal artery thrombosis. In unilateral atherosclerotic renal artery stenosis, angioplasty is a drug-sparing procedure that involves some morbidity. Previous uncontrolled and unblinded assessments of angioplasty overestimated its potential for lowering blood pressure.

View PDF Chat

Arterial stenting and balloon angioplasty in ostial atherosclerotic renovascular disease: a randomised trial

1999-01-01

Peter JG van de Ven , Robert Kaatee , Jaap J. Beutler +5 more

STUDIES ON EXPERIMENTAL HYPERTENSION

1934-03-01

Harry Goldblatt , James E. Lynch , R. F. Hanzal +1 more

These experiments indicate that, in dogs at least, ischemia localized to the kidneys is a sufficient condition for the production of persistently elevated systolic blood pressure. When the constriction of … These experiments indicate that, in dogs at least, ischemia localized to the kidneys is a sufficient condition for the production of persistently elevated systolic blood pressure. When the constriction of both main renal arteries is made only moderately severe in the beginning, the elevation of systolic blood pressure is unaccompanied by signs of materially decreased renal function. In this respect the hypertension in these animals resembles the hypertension which is associated with so called benign nephrosclerosis in man. Subsequent increase of the constriction of the main renal arteries does not materially damage renal function, probably because of adequate development of accessory circulation. More delicate methods for detecting a change may yet prove that some damage does occur. Almost complete constriction of both main renal arteries, from the beginning, results in great elevation of systolic blood pressure which is accompanied by severe disturbance of renal function and uremia. This resembles the type of hypertension which is associated with so called malignant nephrosclerosis, in the sense of Fahr (17). In several of the animals with persistent elevation of systolic blood pressure, anatomical changes were observed in the glomeruli, vessels and parenchyma of the kidneys which are most probably directly referable to the ischemia. It is hoped that these investigations will afford a means of studying the pathogenesis of hypertension that is associated with renal vascular disease.

View PDF Chat

Stent Placement for Renal Arterial Stenosis: Where Do We Stand? A Meta-analysis

2000-07-01

Trude C. Leertouwer , Elma J. Gussenhoven , Johanna L. Bosch +4 more

To perform a meta-analysis of renal arterial stent placement in comparison with renal percutaneous transluminal angioplasty (PTA) in patients with renal arterial stenosis.Studies dealing with renal arterial stent placement (14 … To perform a meta-analysis of renal arterial stent placement in comparison with renal percutaneous transluminal angioplasty (PTA) in patients with renal arterial stenosis.Studies dealing with renal arterial stent placement (14 articles; 678 patients) and renal PTA (10 articles; 644 patients) published up to August 1998 were selected. A random-effects model was used to pool the data.Renal arterial stent placement proved highly successful, with an initial adequate performance in 98% and major complications in 11%. The overall cure rate for hypertension was 20%, whereas hypertension was improved in 49%. Renal function improved in 30% and stabilized in 38% of patients. The restenosis rate at follow-up of 6-29 months was 17%. Stent placement had a higher technical success rate and a lower restenosis rate than did renal PTA (98% vs 77% and 17% vs 26%, respectively; P <.001). The complication rate was not different between the two treatments. The cure rate for hypertension was higher and the improvement rate for renal function was lower after stent placement than after renal PTA (20% vs 10% and 30% vs 38%, respectively; P <.001).Renal arterial stent placement is technically superior and clinically comparable to renal PTA alone.

View PDF Chat

Stenting and Medical Therapy for Atherosclerotic Renal-Artery Stenosis

2013-11-18

Christopher J. Cooper , Timothy P. Murphy , Donald E. Cutlip +7 more

Atherosclerotic renal-artery stenosis is a common problem in the elderly. Despite two randomized trials that did not show a benefit of renal-artery stenting with respect to kidney function, the usefulness … Atherosclerotic renal-artery stenosis is a common problem in the elderly. Despite two randomized trials that did not show a benefit of renal-artery stenting with respect to kidney function, the usefulness of stenting for the prevention of major adverse renal and cardiovascular events is uncertain.We randomly assigned 947 participants who had atherosclerotic renal-artery stenosis and either systolic hypertension while taking two or more antihypertensive drugs or chronic kidney disease to medical therapy plus renal-artery stenting or medical therapy alone. Participants were followed for the occurrence of adverse cardiovascular and renal events (a composite end point of death from cardiovascular or renal causes, myocardial infarction, stroke, hospitalization for congestive heart failure, progressive renal insufficiency, or the need for renal-replacement therapy).Over a median follow-up period of 43 months (interquartile range, 31 to 55), the rate of the primary composite end point did not differ significantly between participants who underwent stenting in addition to receiving medical therapy and those who received medical therapy alone (35.1% and 35.8%, respectively; hazard ratio with stenting, 0.94; 95% confidence interval [CI], 0.76 to 1.17; P=0.58). There were also no significant differences between the treatment groups in the rates of the individual components of the primary end point or in all-cause mortality. During follow-up, there was a consistent modest difference in systolic blood pressure favoring the stent group (-2.3 mm Hg; 95% CI, -4.4 to -0.2; P=0.03).Renal-artery stenting did not confer a significant benefit with respect to the prevention of clinical events when added to comprehensive, multifactorial medical therapy in people with atherosclerotic renal-artery stenosis and hypertension or chronic kidney disease. (Funded by the National Heart, Lung and Blood Institute and others; ClinicalTrials.gov number, NCT00081731.).

View PDF Chat

Rethinking Chronic Allograft Nephropathy

1999-01-01

Philip F. Halloran , Anette Melk , Cláudia Barth

Chronic rejection or chronic allograft nephropathy (CAN) is the major cause of failure of kidney transplants other than patient death, and has been extensively reviewed (1,2,3,4,5). CAN is characterized by … Chronic rejection or chronic allograft nephropathy (CAN) is the major cause of failure of kidney transplants other than patient death, and has been extensively reviewed (1,2,3,4,5). CAN is characterized by functional impairment with nonspecific pathology: tubular atrophy, interstitial fibrosis, and fibrous intimal thickening (FIT) in the arteries, with variable glomerular lesions. The risk of CAN correlates with the input, immune, and load stresses experienced by that kidney. Input refers to the preexisting chronic conditions in the donor (aging, hypertension) plus the acute injury related to the transplant process (brain death, donor maintenance, organ removal, preservation, implantation, reperfusion). Immune stress is due to rejection by antibody or cellular mechanisms, determined by histocompatibility, presensitization, host responsiveness, and the effectiveness of and compliance with immunosuppression. Load reflects hypertension, donor-recipient size disparity, proteinuria, hyperlipidemia, drug toxicity, and infectious agents. Load factors such as donor size and gender probably reflect differences in nephron dose and are relatively weak, suggesting that nephron number does not explain the strong effect of input and immune factors. What distinguishes the transplant from normal tissue is the level of injury. Injury depletes the finite ability of the tissue to repair, and triggers inflammation, which may further stress the parenchyma and vessels, increase immune recognition, and promote fibrosis. In this article we review the problem of human CAN and propose a model in which the cumulative burden of injury and age exhausts the ability of key cells in epithelium or endothelium to repair and remodel to maintain tissue integrity. We term this exhaustion "senescence" to emphasize the importance of donor aging and the overlap of the pathologic lesions with age-related changes, and to suggest analogy with senescent changes observed in cell culture. When the potential of a tissue to repair is exhausted, the endothelial functions decline and the epithelium atrophies; injury-induced inflammation persists, permitting transforming growth factor-β and other mediators to create fibrosis. Thus, fibrosis may be a default for the failure of normal healing. CAN can be minimized by reducing the burden of injury due to immune and nonimmune mechanisms, but grafts with age- and injury-induced changes may still be useful despite their limitations, and few should be discarded. Recent advances in the cellular basis of senescence in vitro may hold clues to the molecular events that limit the repair of key cells. Development of the Concept of Chronic Rejection and CAN The concept of chronic rejection emerged gradually in the 1950s and 1960s. Acute homograft (now allograft) rejection was well known in the late 1950s in the early clinical experience, and few kidneys survived even for months. In 1955 Hume et al. (6) reported a case in which rejection developed within 5½ mo, with obliteration of the arteries. Systematic investigation of late rejection by Porter et al. (7) and Jeannet et al. (8) revealed that arterial intimal fibrosis was frequent and probably represented a reaction to immune injury, perhaps due to alloantibody (7,9). This may explain the belief that chronic rejection is alloantibody-mediated. Transplant glomerulopathy distinct from recurrent glomerulonephritis was recognized by the late 1960s and early 1970s (10,11,12,13), and is a variable feature of CAN. However, these early observations by Hume, Porter, Jeannet, and their colleagues in transplants on minimal immunosuppression bear little resemblance to the type of late graft loss in the 1990s. The syndrome of obliterative arterial disease progressing over months is now rare, and the clinical course of CAN is usually indolent, with graft loss often many years posttransplant. The arterial lesions are often not prominent in biopsies early in the course. However, the old Hume-Porter-Jeannet syndrome remains the basis of the current animal models of chronic rejection, making them of limited relevance to the clinical problem of CAN. The Problem of Definition We avoid the term chronic rejection because it implies an ongoing immune response that cannot be proven. We cannot determine the extent of immune involvement in CAN at present, and the risk factors indicate a large nonimmune component. Previous efforts to define chronic rejection as a distinct disease often included an arbitrary rate of progression. Such definitions exclude kidneys with poor but stable function, while including kidneys with better function that have experienced recent deterioration. Moreover, progression is often irregular (14), and progression per se is not a criterion for defining other renal diseases. We define CAN as a state of impaired renal allograft function at least 3 mo posttransplant, independent of acute rejection, overt drug toxicity, and recurrent or de novo specific disease entities, with typical features on biopsy (see below). One can designate graft loss due to CAN, and can define progressive CAN by an arbitrary change over time. Such definitions avoid the problem of defining chronic rejection so rigorously that one excludes much of the population of interest. Magnitude of the Problem of CAN The two largest problems in renal transplantation are organ availability and late graft loss. A transplant is beneficial compared to remaining on the waiting list (15) and is the treatment of choice for end-stage renal disease. However, the average cadaver donor transplant fails at about 10 yr. CAN is the main cause of returning to dialysis after a transplant (4,16) and a major cause of end-stage renal disease in the developed world, increasing the number of people on dialysis and using up kidneys for retransplantation. CAN contributes to the prevalence of hypertension and renal insufficiency. For example, currently in the 600 patients with renal transplants followed in Edmonton, 35% have creatinine > 150 and 15% >200 mM/L. Improved immunosuppression has reduced acute rejection but has had little effect on CAN and late graft loss. CAN is more common in cadaver donor transplants than living donor transplants but the clinical course is similar in live donor transplants once it is established. The Pathology of CAN The pathology of CAN is nonspecific and requires exclusion of specific entities. The CAN triad—tubular atrophy, interstitial fibrosis, and FIT—is shown in Figure 1, and is the basis for the Banff classification of CAN (17,18). (The updated diagnostic categories for CAN are listed at http://tpis.upmc.edu/tpis/schema/index.html.) All CAN lesions including the vascular lesions often considered the hallmark of CAN overlap the lesions in the aging kidney (19). Thus, many kidneys now being transplanted fulfill the criteria for CAN at the time of transplant. The prevalence of CAN lesions in cadaver transplants is about 60 to 70% by 2 yr (20), but it is not clear in most studies how much was present at the time of transplant. The key feature may be epithelial atrophy, associated with a reduction in renal mass. There is an impressive increase in relative interstitial area and alpha smooth muscle actin in sections, but it is difficult to assess the absolute increase in collagen and the prominence of myoblasts in the interstitium because the kidney has decreased in size (21). A new lesion, splitting of the peritubular capillary basement membrane detected by electron microscopy, may be more specific for CAN and is under evaluation (22,23).Figure 1.: The injury triangle.Chronic rejection has been considered synonymous with transplant vascular sclerosis, based on the assumption that vascular sclerosis causes the epithelial atrophy and interstitial fibrosis. This may not be correct, and vascular sclerosis is not a synonym for CAN or chronic rejection. Compared with focal, eccentric, and proximal lesions of conventional atherosclerosis, the arterial lesions in CAN have been described as generalized, concentric, and distal, similar to the lesions in chronic rejection of coronary arteries in heart transplantation. However, such generalizations are suspect. By light microscopy, no lesions are present in CAN that are not also present in some donor kidneys pretransplant (24), and one of the strong associations of CAN lesions is with donor age (25). Indeed, the majority of graft dysfunction at 6 mo posttransplant is determined by the donor (25,26). Similarly, in heart transplants examined by intravascular ultrasound, the transplant coronary artery disease actually is proximal and eccentric like conventional atherosclerosis (27), not the distal, concentric process originally described. There are differences in the extracellular matrix composition between conventional atherosclerosis and transplant coronary artery disease, but these may reflect the age of the lesion or the speed of development. Thus, the arterial changes in kidney transplants and coronary vasculopathy in heart transplants may represent acceleration of the conventional arterial disease associated with aging. FIT in arteries involves smooth muscle cell proliferation and increased lipid- and glycosaminoglycan-rich matrix in the intima, narrowing the lumen. But part of the loss of lumen in diseased vessels is due to failure of the vessel wall to dilate in response to decreased flow (28), and represents exhaustion of the normal remodeling process, possibly due to decreased endothelial function. According to Schwartz (29), "atherosclerosis results from growth of plaque and, ultimately, from the failure of the rest of the vessel to dilate as it should in response to reduced blood flow." Thus, the focus on the intimal proliferative changes should be replaced by the concept of a more global disorder of arterial remodeling. In CAN, both renal function (30) and histology (31) correlate with the ultimate prognosis of the graft. For example, the chronic allograft dysfunction index at 2 yr correlates with transplant function at 6 yr, and with eventual graft failure. However, it is doubtful whether pathology, with its inherent sampling error, predicts progression more accurately than does the serum creatinine or GFR, which lack the elegance of pathology but are more precise, reproducible, and quantitative. Clinical Factors: Input, Immunity, Load Our understanding of CAN has emerged from the human renal transplant experience. Because most late graft loss is due to CAN, the risk factors for late allograft failure can be taken as a surrogate for CAN. Factors that increased the probability of graft failure in various databases are summarized as quality of the transplanted tissue (input), the rejection events, and the posttransplant load or stress on the organ (Table 1) (3,26,30,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49,50).Table 1: Risk factors for renal graft lossaInput: The Quality of the Transplanted Tissue There are two aspects of input quality: chronic changes from stresses and injuries in the donor, and the acute peritransplant injuries that arise in donation and transplantation. The use of older and "marginal" donors or expanded criteria for donor acceptability are increasing the importance of acute and chronic input effects (51). In the past, the donors were usually young male trauma victims, and now are increasingly likely to be older, with strokes, and female. The result is that nonspecific input injury is rivaling rejection as the major process causing CAN and graft failure. Chronic Pretransplant Injuries Donor age is the strongest predictor of poor long-term graft survival (52,53,54,55), and CAN lesions strongly correlate with older donor age (25). Kidneys from older donors show an increased frequency of later adverse features: delayed graft function and elevated baseline serum creatinine. The aging kidney develops increasing functional impairment, particularly in men (56), due to age and age-related diseases such as hypertension and vascular disease (57). Age-related loss of renal mass is primarily cortical with sparing of the medulla. The number of glomeruli decreases due to global sclerosis, and the remaining glomeruli enlarge. Focal glomerular sclerosis is not a major finding in age-related changes (or for that matter in CAN). The percentage of sclerotic glomeruli increases from 5% in the fourth decade to 10 to 30% in the eighth decade (57). Lesions similar to the CAN triad are prominent in the aging kidney. The FIT lesions correlate with diminished renal weight, but it is not clear that FIT causes nephron loss or glomerulosclerosis. Infiltrates of inflammatory cells in the interstitium occur probably as a response to injury. Effects of donor age explain about 30% of the variance in kidney transplant outcomes beyond 1 yr (55). The effects of donor aging have been considered to be due to reduced nephron dose. However, the effects of donor age and other input parameters are considerably stronger than the measures of nephron dose, such as donor size and gender, which contribute only 1 to 2% of the variance (55). Thus, intrinsic changes in the aging kidney probably both contribute more to the reduced survival than nephron dose per se. As we argue below, this may be a result in inherent "clocks" in the cells, rather than overwork due to nephron dose. In other words, the age of the nephrons and the number of nephrons may both affect graft survival. In cadaveric renal transplantation, the degree of glomerulosclerosis (as a percentage of the total glomeruli seen) has been used as the basis for excluding certain donors. This may not be valid, due to sampling errors, particularly in superficial wedge biopsies, and because sclerosis may not be the best predictor of subsequent graft performance. The extent of FIT may better predict renal tissue quality (H. Wang, K. Solez, S. Cockfield, manuscript in preparation; B. Kasiske, personal communication). In multivariate analysis, the gender and size of the donor affects the outcome significantly but weakly (55). Gender and size differences probably reflect nephron dose (58), and are discussed below as load factors. Acute Peritransplant Injuries Delayed graft function (DGF) is a strong correlate of reduced graft survival, reflecting acute injury related to the donation and transplant process, although it is likely that preexisting chronic changes such as FIT also increase DGF. This reflects the increased susceptibility of the kidney with chronic stress to acute injury, as seen in acute renal failure of other causes (59). DGF has been attributed to ischemia-reperfusion injury, but is more complex than this. One key factor may be renal injury due to brain death itself, which can now be studied in rats (N. Tilney, personal communication), and is both profound and poorly understood in many tissues in the hours following brain death. DGF reflects the total of many injuries: brain death, donor maintenance, warm ischemia, cold flush and preservation, rewarming during the anastomosis, reperfusion, and intrarenal arterial spasm in the hours after the anastomosis. DGF is increased in patients with high panel-reactive antibodies (60), perhaps because undetected alloantibody-mediated rejection can present as acute tubular necrosis. Despite HLA mismatching, grafts from living spousal donors show enhanced survival compared with cadaveric transplants (38), emphasizing the long-term consequences of the peritransplant stresses of cadaveric transplantation. Increasing cold ischemic time and other preservation/harvesting times (warm ischemic time, anastomosis time) represent risk factors for immediate function and long-term survival, suggesting that current conditions for cadaveric donation and preservation are not optimal. The concepts of renal preservation date to the 1960s and need to be reevaluated (61). Even the idea of cold flush and cold preservation should be reconsidered, since cold stress could be counterproductive (62). Moreover, the practices in organ donation have been adjusted to improve the function of the lungs, liver, heart, pancreas, etc., sometimes at the expense of added renal stress. These stresses may interact with the chronic input stresses in the kidneys with age-related changes. Kidneys from donors who die of brain damage by physical trauma (e.g., motor vehicle trauma) have better survival than those from donors dying from cerebrovascular events (55). Other features of the donor after the brain insult, such as disseminated intravascular coagulation (63), may also influence the future of the graft. Nonrandom associations among factors such as causes of death, gender, age, and age-related disease complicate the interpretation of these relationships. Young male donors with cerebral trauma, large renal mass, no hypertension, and little vascular disease are compared to older donors who are more likely to be female, and to have intravascular accidents, hypertension, and vascular disease. We must continue to refine the multivariate statistical models for these complex, nonrandom, and incompletely understood associations. Immunity Immunologic parameters (histocompatibility differences, acute rejection episodes, presensitization) have a major effect on graft survival. Acute rejection episodes, especially if severe, recurrent, late, or not responding well to treatment, strongly predict the early development of CAN. In some patients, progression of CAN is associated with laboratory evidence of an ongoing donor-specific immune response, e.g., proliferative responses to allopeptides (64) and circulating anti-donor antibodies (65,66). Such findings are neither universal nor proven to be causal, and the prevalence and pathogenic role of alloantibodies and T cells in CAN remains unresolved some four decades after the issue was first raised. The principal considerations about the role of acute rejection in CAN have become clearer in recent years: Freedom from acute rejection correlates strongly with protection from CAN and from late graft loss. The rejection episodes that correlate with late graft loss include those followed by impaired function (32,41); late, severe, or recurrent rejection; and rejection affecting arteries (43,48,67,68). Perfect HLA matching decreases acute rejection rates both early and late and increases graft survival (G. Opelz, personal communication). Decreasing rejection by immunosuppression has had less effect than expected on CAN and late graft loss to date (43,69). The new immunosuppressive agents such as cyclosporin A (CsA), mycophenolate mofetil, and tacrolimus have failed to alter histology or renal function or graft survival despite reducing the rate of acute rejection. Some data favor tacrolimus over CsA for reducing CAN (70), but these may reflect aggressive dosing of tacrolimus compared with CsA in the early tacrolimus studies and have not been confirmed in recent analyses in the Collaborative Transplant Study (G. Opelz, personal communication). Nonimmune parameters such as DGF, donor age, and brain death due to stroke have a powerful influence on graft survival in cadaver transplant databases (37,71), at least as strong as HLA mismatch or any other immune parameter. The role of brain death per se is emphasized by the observation that unmatched spousal transplants survive as well as HLA one haplotype-matched live related donor transplants and better than fully matched cadaver transplants (38). Because injured kidneys reject more, rejection may in part be a marker for input injury and vice versa (60), and rejection may also account for some of the effect of DGF. DGF reduces graft survival even when no acute rejection episodes are recorded, indicating that the effects of DGF are only partially immune-mediated (72). Noncompliance with medications can precipitate acute rejection even very late after transplantation, and may contribute to the failure of immunosuppressive agents to alter transplant half-life. This may explain why HLA matching effects tend to have more effect on transplant half-life than immunosuppressive drugs. (Noncompliance is also a factor in the treatment of hypertension and hyperlipidemia.) Input Injury Interacts with Immune Recognition Kidneys with DGF have more acute rejection (60), and grafts lost without recovering function usually show severe rejection (73). The combination of DGF and rejection gives particularly poor survival (44). Possible reasons for immune problems in kidneys with acute input injury include difficulties in the diagnosis of rejection in DGF, but there may be a true increase in immune recognition in injured tissues. A variety of types of injury elicit a cascade of inflammatory events that contribute to a general stereotyped response to tissue injury and not just to ischemia-reperfusion, i.e., the injury response (74). The immune system is governed by geographic rules, such that antigen expressed in normal tissue tends to be ignored and antigen expressed in injured tissue (which is automatically inflamed via the injury response) is likely to provoke and activate an immune response (75), perhaps in part due to proinflammatory cytokines (76). Injury may act as an adjuvant, increasing expression of MHC antigens in epithelium and endothelium as well as recruiting and activating antigen-presenting cells (77). Injury and inflammation could prevent favorable immune adaptations in the host, perpetuating the immune response. Acute input injury could thus favor rejection, and rejection injury could induce inflammation and new immune activation—the injury triangle (Figure 2). The importance of this sequence in clinical transplantation remains unknown.Figure 2.: Histopathology of chronic allograft nephropathy (CAN) showing fibrous intimal thickening, tubular atrophy, and interstitial fibrosis. (A) Fibrous intimal thickening; (B) tubular atrophy with interstitial fibrosis.Whereas acute input injuries (as manifest by DGF) increase rejection, the chronic stresses such as age-related changes may not. It is conceivable that donor atherosclerosis might render vessels and parenchyma more immunogenic. Atherosclerosis has features of chronic inflammation, with increased T cells (CD8-positive more than CD4-positive T cells) and monocytes in the intima of atherosclerotic vessels, MHC class II expression, and adhesion molecules ELAM-1, VCAM-1, and ICAM-1 expressed in endothelial cells, and increased expression of many cytokines (78). The FIT and atherosclerotic lesions could thus theoretically facilitate immune recognition. However, in human transplants the deleterious effects of advancing donor age and vascular disease are clear but their association with rejection is not. Load The nonimmune posttransplant factors postulated to affect graft survival include the mechanisms of progression of chronic renal disease in native kidneys. Thus, current discussion focuses on recipient size and gender, hypertension, lipid disorders, proteinuria, and cytomegalovirus (CMV). Such effects could operate either nonimmunologically, or could stress the tissue, evoke inflammation, and thus elicit immune recognition. Gender of the Recipient Graft survival is slightly better in female recipients of male kidneys, an effect usually ascribed to nephron dose (see below), although factors relating to patient survival, underlying diseases, sensitization, and other factors complicate such analyses. Females have more active immune responses, and pregnancy could affect female responsiveness to alloantigens through sensitization, tolerance, or persistent microchimerism. Nephron Dose and the Hyperfiltration Hypothesis Low nephron mass or "nephron endowment" has been proposed as a risk for progression of primary renal disease (58) and CAN. Very large recipient size and recipient male gender significantly reduce graft survival in multivariate analyses (55), although it is not clear that these risks reflect increased CAN in the transplant. Excessive donor size could induce hyperfiltration (79,80) and subsequent glomerular sclerosis, as documented in rats (81,82). However, the effects of gender mismatch and recipient size are small compared with the effects of donor age and DGF, and there is little evidence that focal sclerosis is a principal mechanism of progression in human CAN, or even that CAN primarily affects glomeruli. A large mass of transplanted tissue relative to the recipient mass may dampen the immune response. In experimental animals, more tissue generally correlates with more stability, buffering the immune attack and promoting stability, and thus conferring an immunologic advantage (83). Tissue mass may contribute to the tolerogenic properties of liver transplants (84). Very low nephron mass may also evoke inflammation, as has been shown in rat models (85). CMV Infection Kidneys from CMV-positive donors are associated with small reductions in graft survival in United Network of Organ Sharing (86), U.S. Renal Data System (35), and the Collaborative Transplant Study (G. Opelz, personal communication). It is not clear whether this reflects an increased risk of CAN. CMV may be associated with chronic rejection of liver transplants (87) and heart transplants (88,89). Analysis of symptomatic CMV illness has been correlated with the development of chronic rejection, but such observations are colored by the association of clinical CMV manifestations with heavy antirejection therapy and thus with severe rejection. Thus, the case that CMV causes human CAN remains unproven. If CMV plays some role in CAN, improvements in CMV prophylaxis and treatment may reduce CAN. Whether CMV can cause arterial disease in humans is unknown. A link between CMV infection and vasculopathy has been proposed for coronary restenosis (90). However, studies of kidney allografts with FIT by in situ hybridization, immunohistochemistry, and PCR failed to show CMV protein or DNA in the arteries (91). Proteinuria In grafts with heavy proteinuria, the filtered proteins may be toxic to the tubules. Although this cannot initiate renal injury, it may contribute to progression in some cases (92). Hypertension Hypertension in the recipient is significantly associated with CAN and late graft failure (39,93), either as a cause or an effect. The prevalence in posttransplant hypertension defined by antihypertensive treatment is approximately 75% (94). Pretransplant hypertension in the recipient, the presence of the native kidneys, history of hypertension in the donor, recurrent rejection episodes, impaired graft function, and immunosuppressive drugs such as CsA and steroids correlate with posttransplant hypertension (53,95,96,97,98,99). There is a need to establish the extent to which rigorous control of hypertension can prevent CAN in controlled prospective trials; this would establish that hypertension contributes to CAN. Hyperlipidemia Hypercholesterolemia and hypertriglyceridemia are risk factors for the development of atherosclerosis and are common in transplant patients and presumably contribute to patient mortality from cardiac disease (100,101). The role of hyperlipidemia in the incidence of CAN is separate from the risks of generalized recipient atherosclerosis. Hypertriglyceridemia correlates with CAN (101), but whether lipid abnormalities cause CAN remains unproven. Increased pretransplant cholesterol levels were associated with higher graft damage scores in renal biopsies in one prospective study (102), but other studies have not found a clear association (103,104). The combination of increased triglycerides and VLDL proteins may correlate with future graft failure in kidney transplants (101,103) and in heart transplant recipients (105,106). Thus, lipid abnormalities, especially hypertriglyceridemia, enjoy guilt by association with CAN. At present, lipid lowering with HMG-CoA reductase inhibitor is not indicated for all allograft recipients but should be used if other cardiovascular risk factors are present (107). There are provocative data about immunosuppressive effects of HMG-CoA inhibitors in small studies (108,109). Lipid issues will intensify with the increasing use of rapamycin. One problem for those who advocate that hypertension or lipid abnormalities cause CAN is why such abnormalities would be worse in the transplant versus the host vessels. Perhaps input and immune stress in the transplant blood vessel predisposes them to damage from blood pressure and lipids. Nephrotoxicity of CsA and Tacrolimus The contribution of nephrotoxicity from the calcineurin inhibitors (CsA and tacrolimus) to CAN is difficult to estimate. By definition, CAN excludes obvious cases of drug toxicity. The typical lesion of renal toxicity from calcineurin inhibitors is in afferent arterioles (Figure 3), which develop nodular hyaline thickening with protein deposits, sometimes associated with myocyte changes, and necrosis of individual smooth muscle cells on electron microscopy (110,111,112,113). CsA and tacrolimus produce sustained constriction of the afferent arteriole with upregulation of endothelin receptors (114), causing ischemia and glomerular collapse. GFR may initially appear stable due to adaptive growth and hypertrophy in intact glomeruli. Some analyses suggest that CsA or tacrolimus can increase CAN especially if there are early episodes of toxicity, but higher CsA or tacrolimus levels may also protect against the powerful effects of immune injury (24,25,115). The studies of the administration versus withdrawal of calcineurin inhibitors reflect this balance between beneficial and toxic activities (43,116,117,118).Figure 3.: Histopathology of CsA nephrotoxicity, showing the characteristic lesion of hyalinization of an arteriole.Whether dosing and monitoring of calcineurin inhibitors affect CAN is not clear. Variable oral bioavailability of CsA correlates

Natural history of chronic renal insufficiency after partial and radical nephrectomy

2002-06-01

James M. McKiernan , Rachel Simmons , Jared Katz +1 more

Vascular Endothelial Growth Factor Gene Polymorphisms Are Associated with Acute Renal Allograft Rejection

2002-01-01

Majid Shahbazi , Anthony A. Fryer , Vera Pravica +4 more

ABSTRACT. Acute rejection is a major cause of reduced survival of renal allografts. Vascular endothelial growth factor (VEGF) is a mitogen for endothelial cells and is expressed widely by renal … ABSTRACT. Acute rejection is a major cause of reduced survival of renal allografts. Vascular endothelial growth factor (VEGF) is a mitogen for endothelial cells and is expressed widely by renal tissue and T cells. VEGF influences adhesion and migration of leukocytes across the endothelium. This study investigates whether genetically determined variation in VEGF expression influences the development of renal allograft rejection. VEGF promoter polymorphisms were examined by using sequence-specific primer–PCR in 173 renal transplant recipients. Acute rejection occurred in 38.7%; median time to first rejection episode was 14 d. VEGF in vitro expression was investigated in stimulated leukocytes from 30 controls. The −1154*G and −2578*C alleles were associated with higher VEGF production. VEGF −1154 GG and GA genotypes were significantly associated with acute rejection risk at 3 mo (P = 0.004, odds ration [OR] = 6.8, 95% CI = 1.8 to 25 and P = 0.035, OR = 4.1, 95% CI = 1.1 to 15, respectively). Furthermore, VEGF −2578 CC and CA genotypes were associated with increased rejection risk (P = 0.005, OR = 4.1, 95% CI = 1.5 to 11.3 and P = 0.035, OR = 2.7, 95% CI = 1.1 to 7, respectively). These polymorphisms demonstrate linkage disequilibrium (P = 0.001). These data indicate that the −1154*G and −2578*C containing genotypes, encoding higher VEGF production, are strongly associated with acute rejection and may be useful markers of rejection risk.

The Resistive Index in Renal Doppler Sonography: Where Do We Stand?

2003-04-01

Mitchell Tublin , Ronald O. Bude , Joel F. Platt

Use of Doppler Ultrasonography to Predict the Outcome of Therapy for Renal-Artery Stenosis

2001-02-08

Jörg Radermacher , Ajay Chavan , Jörg S. Bleck +6 more

Prospectively identifying patients whose renal function or blood pressure will improve after the correction of renal-artery stenosis has not been possible. We evaluated whether a high level of resistance to … Prospectively identifying patients whose renal function or blood pressure will improve after the correction of renal-artery stenosis has not been possible. We evaluated whether a high level of resistance to flow in the segmental arteries of both kidneys (indicated by resistance-index values of at least 80) can be used prospectively to select appropriate patients for treatment.

View PDF Chat

Remission of Essential Hypertension after Renal Transplantation

1983-10-27

John J. Curtis , Robert Luke , Harriet P. Dustan +4 more

Six patients in whom "essential hypertension" led to nephrosclerosis and kidney failure received kidney transplants from normotensive donors. After an average follow-up of 4.5 years, all were normotensive and had … Six patients in whom "essential hypertension" led to nephrosclerosis and kidney failure received kidney transplants from normotensive donors. After an average follow-up of 4.5 years, all were normotensive and had evidence of reversal of hypertensive damage to the heart and retinal vessels. These six patients, all of whom were black, and six control subjects matched for age, sex, and race were admitted to the General Clinical Research Center for 11 days for observation of their blood pressure and their responses to salt deprivation and salt loading. Mean arterial pressure (±S.E.M.) among the patients who had previously had essential hypertension was similar to that of the normal controls (92±1.9 vs. 94±3.9; P not significant), and both groups had similar responses to salt deprivation and salt loading. Thus, essential hypertension in human beings is shown to be similar to the hypertension seen in spontaneously hypertensive rats in that both can be corrected by transplantation of a kidney from a normotensive donor. This observation supports the concept of the primacy of the kidney in causing essential hypertension. (N Engl J Med 1983; 309:1009–15.)

Treatment of Ostial Renal-Artery Stenoses with Vascular Endoprostheses after Unsuccessful Balloon Angioplasty

1997-02-13

Ulrich Blum , B. Krumme , Peter Flügel +5 more

Percutaneous transluminal renal angioplasty is a safe and effective treatment for nonostial stenoses of the renal arteries, but it has proved to be disappointing for ostial stenoses. Therefore, we prospectively … Percutaneous transluminal renal angioplasty is a safe and effective treatment for nonostial stenoses of the renal arteries, but it has proved to be disappointing for ostial stenoses. Therefore, we prospectively studied the use of intravascular stents for the treatment of critical ostial stenoses after unsuccessful balloon angioplasty.Stainless-steel endoprostheses were placed across 74 renal-artery stenoses located within 5 mm of the aortic lumen in 68 patients with hypertension. Twenty patients had mild or severe renal dysfunction. The indications for stent placement were elastic recoil (63 arteries) or dissection (1 artery) of the vessel after angioplasty, or restenosis after initially successful balloon angioplasty (10 arteries). Patients were followed for a mean of 27 months with measurements of blood pressure and serum creatinine, duplex sonography, and intraarterial angiography.Initial technical success was achieved in all patients. Minor complications (local hematomas) occurred in only three patients; there were no major complications. Eighty-four percent of the patients were free of primary occlusion 60 months after the procedure. Restenosis of more than 50 percent of the vessel diameter occurred in 8 of 74 arteries (11 percent). Reintervention resulted in a secondary patency rate of 92 percent. Long-term normalization of blood pressure was achieved in 11 patients (16 percent). Serum creatinine levels did not change significantly after successful stent implantation in patients with previously impaired renal function.Accurate placement of renal-artery stents is technically feasible without major complications. The favorable early and long-term results suggest that primary stent placement is an effective treatment for renal-artery stenosis involving the ostium.

View PDF Chat

Non-Transgenic Mouse Models of Kidney Disease

2016-01-01

Michael Rabe , Franz Schaefer

Experimental unilateral ureteral obstruction (UUO) is widely used to study renal fibrosis; however, renal injury can only be scored semiobjectively by histology. We sought to improve the UUO model by … Experimental unilateral ureteral obstruction (UUO) is widely used to study renal fibrosis; however, renal injury can only be scored semiobjectively by histology. We sought to improve the UUO model by reimplanting the obstructed ureter followed by removal of the contralateral kidney, thus allowing longitudinal measurements of renal function. Mice underwent UUO for different lengths of time before ureteral reimplantation and contralateral nephrectomy. Measurement of blood urea nitrogen (BUN) allows objective evaluation of residual renal function. Seven weeks after reimplantation and contralateral nephrectomy, mean BUN levels were increased with longer duration of UUO. Interstitial expansion, fibrosis, and T-cell and macrophage infiltration were similar in kidneys harvested after 10 days of UUO or following 10 weeks of ureter reimplantation, suggesting that the inflammatory process persisted despite relief of obstruction. Urinary protein excretion after reimplantation was significantly increased compared to control animals. Our study shows that functional assessment of the formerly obstructed kidney can be made after reimplantation and may provide a useful model to test therapeutic strategies for reversing renal fibrosis and preserving or restoring renal function.

View PDF Chat

Pathologic classification of renal arterial disease in renovascular hypertension.

1971-03-01

Harrison Eg , McCormack Lj

Neovascularization produced by angiotensin II.

1985-02-01

Fernandez La , Jeff Twickler , A Mead

The Natural History of Atherosclerotic and Fibrous Renal Artery Disease

1984-08-01

Martin J. Schreiber , Marc A. Pohl , Andrew C. Novick

Fibromuscular Dysplasia

2004-04-28

David P. Slovut , Jeffrey W. Olin

Fibromuscular dysplasia is a noninflammatory process that may be difficult to distinguish from vasculitis. It develops in the middle and distal arterial segments, and especially in younger patients, it may … Fibromuscular dysplasia is a noninflammatory process that may be difficult to distinguish from vasculitis. It develops in the middle and distal arterial segments, and especially in younger patients, it may cause renovascular hypertension, stroke, and cranial-nerve palsies. Treatment increasingly involves the use of percutaneous angioplasty.

Extreme Prematurity and Fibroblastic Overgrowth of Persistent Vascular Sheath Behind Each Crystalline Lens* *From the Massachusetts Eye and Ear Infirmary. This investigation is made possible through the Special Fund for Research for Pathology Laboratory.

1942-02-01

T. L. TERRY

US Renal Data System 2014 Annual Data Report: Epidemiology of Kidney Disease in the United States

2015-06-22

Rajiv Saran , Yi Li , Bruce Robinson +7 more

View PDF Chat

US Renal Data System 2017 Annual Data Report: Epidemiology of Kidney Disease in the United States

2018-02-21

Rajiv Saran , Bruce Robinson , Kevin C. Abbott +7 more

View PDF Chat

US Renal Data System 2018 Annual Data Report: Epidemiology of Kidney Disease in the United States

2019-02-21

Rajiv Saran , Bruce Robinson , Kevin C. Abbott +7 more

View PDF Chat

US Renal Data System 2020 Annual Data Report: Epidemiology of Kidney Disease in the United States

2021-03-20

Kirsten L. Johansen , Glenn M. Chertow , Robert N. Foley +7 more

View PDF Chat

Fibromuscular dysplasia

2005-03-01

David P. Slovut , Jeffrey W. Olin

The Kidney: Physiology and Pathophysiology

1992-06-17

George Dunea

Outcome of Renal Allograft Transplantation with Multiple Arteries

2025-06-25

Mohammad Nazrul Islam , Mohammad Abdus Salam , Mohammad Rafiqul Islam +3 more | Bangladesh Journal of Urology

Background: Anatomical variations of the grafts are one of the most difficult issues in renal transplantation. The most prevalent of these anatomical variants is thought to be multiple renal arteries … Background: Anatomical variations of the grafts are one of the most difficult issues in renal transplantation. The most prevalent of these anatomical variants is thought to be multiple renal arteries (MRAs). Objective: To evaluate the short term outcome of renal allograft transplantation with multiple arteries. Methods: This quasi-experimental study was conducted in the Department of Urology, BMU, Dhaka, from December 2022 to November 2024. This study included 18 recipients who had living donor renal transplantation and received MRAs graft. The outcome variables were operation time, total ischemia time, length of hospital stay, post-operative complication and serum creatinine levels. All patients were followed up at the outpatient department initially once a week during the 1st months after discharged from hospital, then once a month for the following six months. Results: The median age of the patients was 40.0 years where 10 (55.6%) patients were female. The median operation time was 207.5 minutes. The median hospital stay of the patients was 18.5 days. In postoperative days, 2 (11.1%) patients had DGF and 1 (5.6%) patient had peri-transplant haematoma. None of them had acute tubular necrosis, renal artery stenosis and acute rejection. At baseline, the median serum creatinine level was 8.05 mg/dl which decreased to 1.49 mg/dl at 1st month. At the end of 6th month, the median serum creatinine level was 1.40 mg/dl. Conclusions: MRAs are safe for renal allograft transplantation, and recipients in need should not be denied grafts with multiple vessels. Bangladesh J. Urol. 2025; 28(1): 22-26

NEFROESCLEROSE HIPERTENSIVA: REVISÃO NARRATIVA DA LITERATURA

2025-06-23

José de Oliveira Melo Neto , Osvando José de Morais , Ana Luiza Narciso Aguiar +3 more | Editora Pasteur eBooks

Carotid web: identifying an often-overlooked cause of stroke during endovascular therapy

2025-06-23

Erik Elseviers , Thomas Jardinet , Caroline M.J. Loos | Acta Neurologica Belgica

Interventional Radiology Management of Renal Artery Stenosis After Kidney Transplant: Single-Center Experience and Management Strategies

2025-06-23

Ahmad Mirza , Munazza Khan , Usman Baig +2 more | Diagnostics

Background/Objectives: The course of treatment for renal artery stenosis following renal transplantation depends on the severity of the condition. Mild cases are typically managed medically, while more significant stenosis with … Background/Objectives: The course of treatment for renal artery stenosis following renal transplantation depends on the severity of the condition. Mild cases are typically managed medically, while more significant stenosis with flow limitation and graft dysfunction requires percutaneous intervention. Surgical treatment is generally reserved as a last resort. This study aimed to evaluate the outcomes of interventional radiology in managing renal artery stenosis at our transplant center. Methods: The electronic medical records of patients who underwent renal transplantation at our center between January 2020 and December 2024 were reviewed to identify cases of renal artery stenosis and their subsequent management through interventional radiology. Sociodemographic and clinical data were collected for both recipients and donors. Data analysis was performed using SPSS version 26. Results: Out of the total 368 patients who received renal allograft at our center from January 2020 to December 2024, 25 patients were confirmed with duplex ultrasound to have renal artery stenosis. The majority of affected patients were African American, had Class I Obesity and presented with cardiovascular co-morbidities. The mean time from transplant to the diagnosis of RAS was 4.25 (SD ± 3.81) months. The mean serum creatinine level at presentation was 2.54 (SD ± 1.21 mg/dL). All 25 patients underwent digital subtraction angiography, and 24 patients were confirmed to have renal artery stenosis requiring further intervention. The creatinine levels at one week, three months and one year post-intervention were 2.12 (SD ± 1.00), 1.83 (SD ± 0.63) and 2.15 (SD ± 1.68) mg/dL, respectively. Conclusions: Percutaneous interventional treatment for renal artery stenosis is associated with improvements in hemodynamic parameters and the stabilization of allograft function. Follow-up is needed to monitor for the potential occurrence of restenosis.

Hemodynamics analysis of fetal intra-abdominal umbilical vein varix using computational fluid dynamics with Doppler ultrasound

2025-06-23

Song Xue , Shengbai Zhang , Mingrui Li +3 more | Research Square (Research Square)

<title>Abstract</title> Fetal intra-abdominal umbilical vein varix (FIUVV) is a rare but potentially risky fetal umbilical cord (UC) vascular anomaly closely related to adverse pregnancy outcomes. Clinically, the diagnosis of FIUVV … <title>Abstract</title> Fetal intra-abdominal umbilical vein varix (FIUVV) is a rare but potentially risky fetal umbilical cord (UC) vascular anomaly closely related to adverse pregnancy outcomes. Clinically, the diagnosis of FIUVV primarily relies on Doppler ultrasound. Unfortunately, it is challenging to provide detailed FIUVV hemodynamics, while current in silico computational fluid dynamics (CFD) can provide these details with necessary ultrasound data. Therefore, this study uses CFD to simulate blood flow in four different geometric FIUVV models based on clinical Doppler ultrasound data. The varix region exhibited marked velocity deceleration, with a reduction of approximately 16-48% compared to the normal umbilical vein (UV) model. In addition, a large low-velocity region forms near the UV wall, where the slow-moving blood flow generates recirculating flow under the influence of the reverse pressure gradient. The pressure within the varicose region remains nearly equal to that at its entrance, while a distinct pressure gradient emerges near the exit of the varicose segment. Within the venous dilatation region, wall shear stress (WSS) decreased to 6% of that in the normal UV model. The downstream end of the varix region, the contraction of vessel diameter and velocity recovery lead to a sharp increase in WSS, with peak WSS reaching three times the normal value in the elongated fusiform and bilobed fusiform umbilical vein varix models. These results predispose to endothelial dysfunction and thrombogenesis and subsequently may impair fetal growth and development. These results underscore the critical role of CFD in elucidating FIUVV pathophysiology, particularly in quantifying thrombosis-prone low-shear zones and endothelial stress hotspots. The methodology provides novel insights into stratifying hemodynamic risks and optimizing prenatal monitoring protocols.

Renal resistive index for the prediction of augmented renal clearance: a prospective observational study

2025-06-23

Mrudula Prasanna , Dilip Shende , R. Ravikumar +4 more | Journal of Ultrasound

Implantation of Totally Implantable Reservoirs and Injection Ports

2025-06-20

Steven D. Waldman | Elsevier eBooks

Use of carotid web angioarchitecture in stratification of stroke risk

2025-06-20

Bruck Negash , Daniel Wiggan , Eric A. Grin +7 more | Journal of NeuroInterventional Surgery

Objective To validate the carotid web (CW) risk stratification assessment described in previous works within a larger cohort of patients with symptomatic and incidentally found asymptomatic CWs. Methods A retrospective … Objective To validate the carotid web (CW) risk stratification assessment described in previous works within a larger cohort of patients with symptomatic and incidentally found asymptomatic CWs. Methods A retrospective analysis of our institution’s electronic medical records identified all patients with a diagnosis of CW from 2017 to 2024. We included symptomatic patients and those with asymptomatic CWs, that is, incidentally found webs without history of stroke or transient ischemic attack. Patient charts were reviewed for demographics, imaging, comorbidities, and a diagnosis of stroke after diagnosis of asymptomatic CW. All angles were measured as described in previous work on a sagittal reconstruction of neck CT angiography in which the common carotid artery (CCA), external carotid artery, and internal carotid artery (ICA) were well visualized, together with the CW itself. Principal component analysis and logistic regression were performed to evaluate the association between high-risk angles and stroke risk. Results Twenty-six symptomatic and 26 asymptomatic patients were identified. Of note, the number of patients with hypertension, hyperlipidemia, and smoking history was 17 (65.0%), 16 (62.0%), and 8 (31.0%) for symptomatic patients and 18 (69.0%), 17 (65.0%), and 15 (58.0%) for asymptomatic patients. All angular measurements showed statistically significant associations with stroke status. The CCA–web-pouch angle showed the strongest association (p=2.07×10⁻⁴), followed by the CCA–pouch-tip angle (p=3.23×10⁻⁴), ICA–web-pouch angle (p=0.004), and ICA–pouch-tip angle (p=0.005). Each additional high-risk angle increased the odds of stroke by 9.47-fold (p<0.0001). The associated probability of stroke increased from 6.3% with no high-risk angles to 39.1% with one high-risk angle and further to 85.9% with two high-risk angles. The model demonstrated high sensitivity, correctly identifying 84.6% of positive cases, and high specificity, correctly identifying 88.5% of negative cases. The F1 score was 0.863, indicating good overall model performance. Conclusion Given this successful stratification of CWs into high- and low-risk groups, the utilization of geometric CW parameters may play a role in improving patient selection for intervention in the setting of incidentally diagnosed CW.

Acute unilateral renal embolism: a therapeutic challenge

2025-06-20

Cheng Long , Xuanlin Chen , Chongjun Shi +4 more | Thrombosis Journal

Acute renal artery embolism (ARAE) is a rare vascular event that precipitates renal infarction (RI) caused by abrupt disruption of renal artery blood flow. RI is frequently misdiagnosed or diagnosed … Acute renal artery embolism (ARAE) is a rare vascular event that precipitates renal infarction (RI) caused by abrupt disruption of renal artery blood flow. RI is frequently misdiagnosed or diagnosed late because of its rarity and frequently ambiguous clinical presentation, potentially leading to irreversible harm to the renal parenchyma or an increased risk of other embolic events affecting other organs. Risk factors for ARAEs include atrial fibrillation, valvular or ischemic heart disease, renal artery embolism/dissection, and coagulopathy, and complete unilateral renal artery embolism is rare. We present the case of one patient with unilateral ARAE caused by atrial fibrillation. We performed percutaneous endovascular therapy (PET) for the renal artery embolism, including catheter-directed thrombolysis (CDT) and aspiration thrombectomy with systemic anticoagulant therapy. At the one-year follow-up, severe atrophy of the affected kidney and compensatory enlargement of the contralateral kidney were observed. We found that procedurally successful revascularization does not necessarily translate to functional recovery of the renal parenchyma. To accurately assess long-term renal functional restoration, we propose incorporating post-thrombectomy anatomical evaluations (e.g., via renal artery angiography or CT angiography [CTA]) combined with functional renal scintigraphy into standardized clinical protocols. This multimodal approach would not only validate the angiographic outcomes but also provide critical insights into the viability of the parenchyma, thereby guiding the development of patient-specific therapeutic strategies. Recommendations for optimal treatment for renal artery embolism are needed. Therefore, we share this case with the aim of providing valuable information for the treatment of renal infarction.

Outcomes of Transperitoneal Laparoscopic Living Donor Nephrectomy: A Single-Center Study in Vietnam

2025-06-19

Nguyen Vu Le , M Cao , Long Nguyen Hoàng +1 more | Research Square (Research Square)

<title>Abstract</title> Purpose (i) describe renal vascular anatomy in Vietnamese donors with 256-slice MSCT; (ii) relate imaging to operative metrics and early outcomes of trans-peritoneal laparoscopic donor nephrectomy (LDN). Methods All … <title>Abstract</title> Purpose (i) describe renal vascular anatomy in Vietnamese donors with 256-slice MSCT; (ii) relate imaging to operative metrics and early outcomes of trans-peritoneal laparoscopic donor nephrectomy (LDN). Methods All consecutive living-kidney donors who underwent trans-peritoneal LDN at Viet Duc University Hospital between January 2023 and June 2024 were prospectively enrolled. Eligibility required compliance with national donation criteria, informed consent, and complete clinical documentation. MSCT data (vessel number, length, diameter, variants) and surgical variables (trocar use, warm-ischaemia time, blood loss, complications) were extracted from electronic records. Results 166 donors (41.6 ± 10.2 year, 59% female) were analyzed. MSCT showed a single renal artery in 77.3% of kidneys and ≥ 2 arteries in 22.7%; multiple veins were more common on the right (14.7%). The left renal vein was far longer than the right (66.0 ± 14.0 vs 25.3 ± 7.4 mm, p < 0.001). Vessel number was predicted correctly in 95.8% of cases, although pedicle length was over-estimated by 3–9 mm (p < 0.001). All nephrectomies were completed laparoscopically. Mean operative time was 118 ± 23 min; warm-ischaemia time 4.5 ± 1.1 min; blood loss 70 ± 33 mL with no transfusions. Intra-operative morbidity was 4.2% (minor only) and 30-day morbidity 9.6%, almost entirely self-limited lymphatic leaks. Drains were removed after 3.5 ± 0.7 days; donors were discharged after 7.2 ± 2.0 days; creatinine fell from 110 to 92 µmol L⁻¹ within one month. Conclusion 256-slice MSCT provides highly accurate vascular mapping that correlates closely with intra-operative findings. When combined with trans-peritoneal LDN, it yields short operative times, low complication rates, and rapid donor recovery, supporting its routine use in living-donor programs in resource-constrained settings.

Common Carotid Artery Web – Unusual Location and Morphology

2025-06-18

Vadivalagianambi Sivakumar , Amarnath Chellathurai , Venkatraman Indiran | Neurology India

Incidental pseudoaneurysm - post-partial nephrectomy, in an asymptomatic patient

2025-06-18

M Thilagavathi , S. Divakar , S Akshayavarsheeni | World Journal of Advanced Research and Reviews

A52-year-old women who had a partial removal of her left kidney a year ago for a renal tumor was asymptomatic and under routine follow-up. During her recent check-up, a contrast … A52-year-old women who had a partial removal of her left kidney a year ago for a renal tumor was asymptomatic and under routine follow-up. During her recent check-up, a contrast enhanced CT scan of her abdomen showed a large pseudoaneurysm in the left renal artery, measuring approximately 79mm by 67mm by 78mm. Because of its size, the medical team performed a safe angioembolization procedure, which went smoothly without any complications.

Nephrosense AI: Risk Detection and Analysis for Chronic Kidney Disease

2025-06-18

Tejaswi Koul , Yogeshchandra Paranjpe , A. K. Nandanwar +2 more | Cureus Journal of Computer Science.

Identification Exploring the Mechanism and Clinical Validation of Mitochondrial Dynamics-Related Genes in Membranous Nephropathy Based on Mendelian Randomization Study and Bioinformatics Analysis

2025-06-17

Qiuyuan Shao , Nan Li , Huimin Qiu +3 more | Biomedicines

Background: Membranous nephropathy (MN), a prevalent glomerular disorder, remains poorly understood in terms of its association with mitochondrial dynamics (MD). This study investigated the mechanistic involvement of mitochondrial dynamics-related genes … Background: Membranous nephropathy (MN), a prevalent glomerular disorder, remains poorly understood in terms of its association with mitochondrial dynamics (MD). This study investigated the mechanistic involvement of mitochondrial dynamics-related genes (MDGs) in the pathogenesis of MN. Methods: Comprehensive bioinformatics analyses-encompassing Mendelian randomization, machine-learning algorithms, and single-cell RNA sequencing (scRNA-seq)-were employed to interrogate transcriptomic datasets (GSE200828, GSE73953, and GSE241302). Core MDGs were further validated using reverse-transcription quantitative polymerase chain reaction (RT-qPCR). Results: Four key MDGs-RTTN, MYO9A, USP40, and NFKBIZ-emerged as critical determinants, predominantly enriched in olfactory transduction pathways. A nomogram model exhibited exceptional diagnostic performance (area under the curve [AUC] = 1). Seventeen immune cell subsets, including regulatory T cells and activated dendritic cells, demonstrated significant differential infiltration in MN. Regulatory network analyses revealed ATF2 co-regulation mediated by RTTN and MYO9A, along with RTTN-driven modulation of ELOA-AS1 via hsa-mir-431-5p. scRNA-seq analysis identified mesenchymal-epithelial transitioning cells as key contributors, with pseudotime trajectory mapping indicating distinct temporal expression profiles: NFKBIZ (initial upregulation followed by decline), USP40 (gradual fluctuation), and RTTN (persistently low expression). RT-qPCR results corroborated a significant downregulation of all four genes in MN samples compared to controls (p < 0.05). Conclusions: These findings elucidate the molecular underpinnings of MDG-mediated mechanisms in MN, revealing novel diagnostic biomarkers and therapeutic targets. The data underscore the interplay between mitochondrial dynamics and immune dysregulation in MN progression, providing a foundation for precision medicine strategies.

V2 Robotic-assisted partial nephrectomy in a renal transplant using the Hugo RAS system and 3-dimensional computed tomography reconstruction models

2025-06-16

Manuel Pinto , Helena Sousa , Nuno Vinagre +4 more | European Urology Open Science

Prevalence of microalbuminuria and associated risk factors among type 2 diabetic patients attending some selected hospitals in Kano State, Nigeria

2025-06-16

J. Suleiman , N.S. Babale , Muhammad Ahmad +2 more | Sokoto Journal of Medical Laboratory Science

Diabetes mellitus is a major health problem accompanied by severe oxidative stress as well as acute metabolic and late systemic complications. Diabetic nephropathy as one of the late systemic complications … Diabetes mellitus is a major health problem accompanied by severe oxidative stress as well as acute metabolic and late systemic complications. Diabetic nephropathy as one of the late systemic complications is increasing steeply along with diabetes epidemic. Microalbuminuria (MA) as a biomarker plays an important role in the early detection of diabetic nephropathy (DN). The aim of the study was to check the prevalence of microalbuminuria risk factors associated with micro-albuminuria in type 2 diabetic patients. The study recruited 84 normotensive type 2 diabetic patients with and without MA and 84 age and gender-matched apparently healthy individuals as control group. Anthropometric measures including age, height, BMI and weight were assessed among the study participants. Plasma glucose, urea, creatinine, Glycated haemoglobin (HbA1c), urinary creatinine, urinary albumin and microalbuminuria were analyzed. The prevalence of MA among the diabetic patients was 22.6%. The measured anthropometric and biochemical parameters were significantly higher in the diabetic group than the control group (p<0.05). There was a linear increase with positive and significant association between GHbA1ccontrol and MA development as the control worsens. According to disease duration (DOD), MA increased linearly as DOD elongated but the difference was insignificant. Female gender has higher but insignificant MA compared to the male gender. GHbA1c control has a direct effect on MA while disease duration effect may be pronounced as the time prolonged. BMI, gender, urea and FBG have no significant effect on ACR.

A case of renal artery thrombosis causing renal infarction in a patient with atrial fibrillation

2025-06-16

Luke Kohan , Jordan Parker , Amal Mattu | Visual Journal of Emergency Medicine

Chronic Kidney Disease and Ischemic Heart Disease. Medical and Social Aspects

2025-06-15

И. Т. Муркамилов , К. А. Айтбаев , F. A. Yusupov +6 more | Bulletin of Science and Practice

Chronic kidney disease (CKD) is a clinical, laboratory, and instrumental syndrome that develops against the background of the gradual and irreversible loss of nephrons. A key laboratory indicator of CKD … Chronic kidney disease (CKD) is a clinical, laboratory, and instrumental syndrome that develops against the background of the gradual and irreversible loss of nephrons. A key laboratory indicator of CKD is a decrease in the glomerular filtration rate (GFR) to ≤ 60 mL/min/1.73 m². Anemia, hyperuricemia, hyperphosphatemia, and arterial hypertension are the most common conditions accompanying CKD. In the etiological structure of CKD, the leading causes include type 2 diabetes mellitus (T2DM), hypertension, chronic heart failure (CHF), and interstitial nephropathies. Patients with CKD are classified as high or very high cardiovascular risk. Common cardiovascular manifestations in CKD include diastolic dysfunction and left ventricular hypertrophy, high-grade arrhythmias, ischemic heart disease (IHD), and CHF. The pathogenesis of IHD in CKD is characterized by disturbances in lipid, calcium-phosphate, and purine metabolism. In CKD patients, anemia, proteinuria, and hypertension accelerate the development of IHD. Frequent episodes of myocardial ischemia in CKD lead to collagen accumulation and fibrosis, resulting in increased left ventricular stiffness and diastolic dysfunction. Coronary angiography in CKD patients often reveals multivessel and diffuse coronary artery lesions. In end-stage CKD, pronounced coronary artery calcification is observed. The morphological substrate of IHD in CKD is represented by athero- and arteriosclerotic coronary artery damage. Severe coronary calcification complicates stent placement, and the hypertrophied myocardium becomes highly sensitive to reduced hemoglobin levels. The article presents a clinical case of combined CKD and IHD in an elderly patient with a background of T2DM.

Chronic Kidney Disease in Older Adults: Trends in Prevalence and Healthcare Service Quality from 2012 to 2018

2025-06-14

Tim Bothe , Elke Schäeffner , Anna Pöhlmann +7 more | Clinical Kidney Journal

Abstract Background Data on the healthcare service quality for patients with chronic kidney disease (CKD) are vital for guiding practitioners, patients, and healthcare policy makers. We examined new quality indicators … Abstract Background Data on the healthcare service quality for patients with chronic kidney disease (CKD) are vital for guiding practitioners, patients, and healthcare policy makers. We examined new quality indicators for outpatient diagnostics and treatments in older patients with CKD, focusing on trends between 2012 and 2018. Methods The study included cross-sectional German statutory health insurance claims data from four independent random samples (2012, 2014, 2016, 2018), each with 62 200 individuals aged ≥ 70 years. We analyzed coded CKD prevalence and incidence, non-recommended drug prescriptions (dual prescriptions of ACE inhibitors with ARBs; NSAIDs in CKD stage 4–5), as well as albumin/creatinine ratio (ACR) and dipstick testing in incident CKD cases. Results After standardization, the samples included 58.4 to 59.3% females, and mean ages ranging from 77.4 to 78.9 years. CKD prevalence increased from 17.8% (95%-confidence interval [CI] 17.5; 18.1) in 2012 to 25.7% (95%-CI 25.4; 26.1) in 2018. CKD incidence raised slightly from 6.4% (95%-CI 6.2; 6.6) to 7.6% (95%-CI 7.4; 7.9). Non-recommended drug prescriptions, which were below 5% in 2012, decreased by more than half by 2018. ACR and dipstick testing varied inconsistently over time, ranging from 11.4 to 13.5% and 55.4 to 57.2%, respectively. Conclusions CKD prevalence in older adults in Germany rose by 8 percentage points from 2012 to 2018 while prescriptions of non-recommended drugs decreased in patients with CKD, indicating better diagnosis and guideline adherence. However, ACR and dipstick diagnostic was alarmingly low and remained below recommended levels outside kidney specialist care, showing areas for improvement.

Short-Term Outcomes in Membranous Nephropathy: Insights from A Single Study Center

2025-06-13

| Journal of Pakistan Society of Internal Medicine.

Urine test data from treatment centers can predict OD deaths

2025-06-13

Alison Knopf | Alcoholism & Drug Abuse Weekly

A recent study has found that urine drug test (UDT) data can be used to predict overdose deaths within days, instead of the 6 months public health policymakers usually need … A recent study has found that urine drug test (UDT) data can be used to predict overdose deaths within days, instead of the 6 months public health policymakers usually need to wait. In a JAMA Network Open study, researchers from Ohio State and Millennium Health concluded that UDT is an early warning system for emergency medical teams, substance use disorder (SUD) providers on dangerous new drugs like xylazine or nitazenes.

Endothelial CHOP as a central mechanism in renovascular hypertension-induced vascular endothelial dysfunction and cardiac fibrosis

2025-06-13

B. Srinivas , Krishnam Raju Alluri , Paula Fortuno +4 more | Cellular and Molecular Life Sciences

420-P: Baseline Risk and Longitudinal Changes in KidneyIntelX Scores and Their Association with Kidney Outcomes in the CANVAS and CREDENCE Trials

2025-06-13

Erik Moedt , Steven G. Coca , Fergus Fleming +1 more | Diabetes

Introduction and Objective: KidneyIntelX is a composite risk score incorporating biomarkers and clinical variables at baseline for diabetic kidney disease (DKD) progression. We sought to determine the clinical relevance of … Introduction and Objective: KidneyIntelX is a composite risk score incorporating biomarkers and clinical variables at baseline for diabetic kidney disease (DKD) progression. We sought to determine the clinical relevance of KidneyIntelX and thresholds in a large cohort of patients with type 2 diabetes and a broad range of CKD. Methods: We measured tumor necrosis factor receptor (TNFR)-1), TNFR-2, and kidney injury molecule (KIM-1) on banked plasma samples from CANVAS and CREDENCE participants, and executed kidneyintelX.dkd at baseline and year 1. We assessed the association of baseline and changes in kidneyintelX.dkd with a composite kidney outcome of 40% decline in eGFR or kidney failure. Hazard ratios were estimated using multivariate Cox regression. Results: There were 4677 participants (mean eGFR 69.4 mL/min/1.73m2; median UACR 77.0 mg/g) with available plasma samples. At baseline, kidneyintelX.dkd scored 867 (18.5%) as high, 1520 (32.5%) as moderate, and 2290 (49.0%) as low risk. The adjusted HR per doubling in predicted probability was 2.26 (95% CI 1.80-2.84). At year 1, the median change in KidneyIntelX predicted probabilities was 0.0%, with &gt;10% reduction in 25.6% of canagliflozin- vs. 17.0% of placebo-treated patients. The adjusted HR for the change in predicted probability from baseline to year 1 was 2.24 (95% CI 1.65-3.04). Canagliflozin led to more patients shifting to lower risk at year 1 (32.1% vs. 16.2% moderate to low; 38.9% vs 19.7% high to moderate or low). Low risk at year 1 was associated with very low kidney outcome risk of 0.3 events per 100 person-years, while staying at moderate had 1.4, moving from high to moderate had 2.2, and high risk at year 1 had 8.9. Conclusion: Baseline and year 1 KidneyIntelX risk assessments in patients with type 2 diabetes and CKD robustly stratified patients for DKD progression independently of classic predictors and should be considered for enriching clinical trials and assessing treatment response. Disclosure E. Moedt: None. S. Coca: Consultant; Renalytix, Bayer Pharmaceuticals, Inc, Alexion Pharmaceuticals, Inc, Vera Therapeutics, Mylan. F. Fleming: Employee; Renalytix. H.L. Heerspink: Consultant; Alnylam Pharmaceuticals, Inc, Alexion Pharmaceuticals, Inc, AstraZeneca, Bayer Pharmaceuticals, Inc, Boehringer-Ingelheim, Eli Lilly and Company, Janssen Pharmaceuticals, Inc, Novartis AG, Novo Nordisk A/S, Roche Pharmaceuticals, Traveere Pharmaceuticals, Menarini.

406-P: The Risk Factor Changes for Diabetic Kidney in T2DM during 13-Year Period in Beijing Community

2025-06-13

XUE LIAN ZHANG , Ming Lü , Shen-Yuan Yuan +1 more | Diabetes

Introduction and Objective: It is well known that diabetic kidney (DN) disease is a risk factor for cardiovascular diseases (CVD) in patients with type 2 diabetes mellitus (T2DM). The aim … Introduction and Objective: It is well known that diabetic kidney (DN) disease is a risk factor for cardiovascular diseases (CVD) in patients with type 2 diabetes mellitus (T2DM). The aim of this study is to investigate the risk factor changes for DN in T2DM during 13-year period in Beijing community. Methods: 1,428 patients with T2DM in the Beijing community were enrolled in 2008, while 1,267 patients were enrolled in 2021. All patients were divided into two groups. Patients without DN were named as the Non-DN group; Patients with DN were named as the DN group. Chronic kidney disease staging was categorized using AER (mg/d) and eGFR (mL/min/1.73 m2). Results: In 2008, there were significant differences between Non-DN group and DN group in comparison of demographic and clinical characteristics, such as age, gender, the proportion of people with smoker, the duration of DM, BMI, WHR, neck circumstance, SBP, DBP, the levels of HbAlc, HDL-c and uric acid (P&lt;0.05). In 2021, when compared with the Non-DN group, the proportion of people with smoker, BMI, heart rate, DBP, the levels of PPG and uric acid were higher in the DN group (P&lt;0.05). The potential confounding factors for DN progression showed that SBP and PPG were independent risk factors in 2008, while neck circumstance, total cholesterol and LDL-c were independent risk factors for DN in 2021. Conclusion: In 2008, blood pressure and blood glucose were the main risk factor for DN progression. From 2008 to 2021, the risk factors of DN changed to clinical characteristics reflecting obese and lipid profiles for T2DM in the community. Interventions should be more up-to-date and focus on weight and lipid management. Disclosure X. Zhang: None. M. Lu: None. S. Yuan: None. Funding A Capital Medical Development Foundation of China (2007-1035), a Grant of Special Scientific Research on Capital Health Development (2011-2005-01,2016-1-2057), Beijing Municipal Science & Technology Commission (Z151100004015021), BRIDGES Grant from the International Diabetes Federation.

Understanding endothelial dysfunction in kidney transplantation: assessment techniques, existing evidence and research needs

2025-06-13

Fotini Iatridi , Eleni Karkamani , Marieta Theodorakopoulou +1 more | Expert Review of Cardiovascular Therapy

KTRs have substantially lower risk for cardiovascular events compared to dialysis, but it remains significantly higher than that in general population, due to the synergistic action of traditional and nontraditional … KTRs have substantially lower risk for cardiovascular events compared to dialysis, but it remains significantly higher than that in general population, due to the synergistic action of traditional and nontraditional factors. Among them, endothelial dysfunction is suggested to be involved pathogenetically in cardiovascular and renal disease progression, with its improvement being another potential benefit of transplantation. VOP was the first technique to be used, followed by several functional methods, most commonly FMD. Over the years, several biomarkers of endothelial dysfunction have been used to assess microvascular function. The totality of evidence in KTRs suggests the improvement of endothelial dysfunction after transplantation, but with several gaps in knowledge, including rarity of studies using novel, more accurate techniques. This review presents the current functional methods and biomarkers used to evaluate microvascular and endothelial function in KTRs, discussing the existing evidence on their changes after transplantation and their associations with comorbidities and outcomes in this population. A comprehensive literature search was conducted in PubMed and Scopus for articles published until December 2024. Novel methods assessing endothelial function offer a comprehensive, real-time evaluation of microvascular function and should be more widely used to enhance our understanding in this area.

Combined percutaneous renal artery denervation and angioplasty: still too early to consider them complementary?

2025-06-12

Fortunato Iacovelli , Luigi Salemme , Rocco Tritto +4 more | Journal of Hypertension

In case of renovascular hypertension, percutaneous renal artery transluminal angioplasty alone is still far from demonstrating predictable clinical results. Assuming a potential synergistic effect, we reported the first case of … In case of renovascular hypertension, percutaneous renal artery transluminal angioplasty alone is still far from demonstrating predictable clinical results. Assuming a potential synergistic effect, we reported the first case of combined percutaneous renal denervation and angioplasty as intention-to-treat strategy in a very high cardiovascular risk patient. Graphical abstract: http://links.lww.com/HJH/C752

Carotid Revascularization Versus Medical Management for Ischemic Stroke with Ipsilateral Carotid Web: A Systematic Review and Meta‐Analysis

2025-06-12

Farhan Khan , Chaudhury Abdul Rehman , Lauren Fletcher +5 more | Annals of Neurology

Objectives Carotid artery web is an underrecognized cause of ischemic stroke and is associated with a high risk of recurrent events. It is uncertain whether medical management or carotid revascularization … Objectives Carotid artery web is an underrecognized cause of ischemic stroke and is associated with a high risk of recurrent events. It is uncertain whether medical management or carotid revascularization is beneficial for patients with ischemic stroke and ipsilateral carotid web. In the absence of large randomized clinical trials and observational studies, we performed a systematic review and meta‐analysis comparing medical management and carotid revascularization in this population. Methods The systematic review was registered in PROSPERO (CRD42024485069). We searched five databases: Embase, Scopus, MEDLINE, Web of Science, and CINAHL. We included observational studies that studied the association between recurrent stroke in patients with ipsilateral carotid web receiving medical management (antiplatelet and anticoagulation) and carotid revascularization. Random effects modeling was performed, and risk ratio with 95% confidence intervals were reported. Results We included 17 studies (16 published and 1 institutional study). In the medical management group, 32% (90/281) of patients experienced recurrent ischemic stroke ipsilateral to the carotid web. The meta‐analysis revealed a significantly lower risk of recurrent ischemic stroke with carotid revascularization (relative risk 0.11, 95% confidence interval 0.06–0.28, p < 0.001, I 2 = 14.5%). Both carotid endarterectomy and carotid artery stenting were equally effective in reducing recurrent stroke risk (relative risk 0.44, 95% confidence interval 0.11–1.76, p = 0.99). Interpretation Carotid revascularization is associated with reduced recurrence rates, with no difference between revascularization subtypes (carotid endarterectomy vs carotid artery stenting). However, given the small, heterogeneous cohorts and the uncertain natural history of carotid artery web under medical management, these findings should be interpreted with caution until prospective, controlled comparative effectiveness studies are performed. ANN NEUROL 2025

A rare renal vascular variant

2025-06-11

Sridevi Chinta , Phani Chakravarty Mutnuru , Anu Kapoor | The Journal of Clinical and Scientific Research

Abstract Renal vasculature consists of arteries and veins along with their branches and tributaries. The renal arteries usually arise from the abdominal aorta. Additional or multiple renal arteries are present … Abstract Renal vasculature consists of arteries and veins along with their branches and tributaries. The renal arteries usually arise from the abdominal aorta. Additional or multiple renal arteries are present in up to one-third of the population. Variations of renal veins are usually clinically silent and remain unnoticed until discovered during surgery, autopsy or imaging. Here, we report the case of renal vasculature variant in a 50-year-old female that was discovered incidentally. There was an accessory renal artery on the right side that was arising from the right common iliac artery and an accessory renal vein on the same side that was draining into the contralateral common iliac vein.

The R-One robotic system for percutaneous coronary intervention: Insights from the Robo-SIL Registry

2025-06-10

Paweł Gąsior , Radosław Liszka , Marta Bujak +7 more | Kardiologia Polska

Vascular and lymphatic complications after renal transplant

2025-06-06

Claire E. White-Dzuro , Demetrios J Geanon , Brian M Fagel +5 more | Abdominal Radiology

Abstract Renal transplant is a life-saving treatment option for patients with end-stage renal disease. As with any intervention, transplantation is not without potential complications, which include disruption to arterial, venous … Abstract Renal transplant is a life-saving treatment option for patients with end-stage renal disease. As with any intervention, transplantation is not without potential complications, which include disruption to arterial, venous and lymphatic structures in the region and can involve either native or transplanted anatomy. Management options range from open surgical intervention to endovascular procedures, the latter of which have become increasingly more prevalent due to their minimally invasive nature. Interventional Radiology has a diverse procedural skillset that can be utilized for successful management of post-transplant complications. Treatment modalities include, but are not limited to, embolization, thrombectomy and stent placement. The goal of this article is to explore common vascular and lymphatic complications that occur following renal transplant and review relevant minimally invasive management options. Positive treatment outcomes are essential to ensure graft, and in turn, patient survival.

Robot-assisted Management of Complex Ureteral Stenosis in Kidney Transplant Patients: Multicenter Case Series and Description of Surgical Techniques

2025-06-03

Joris Vangeneugden , Federico Lavagno , Camille Berquin +7 more | European Urology Open Science