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Should we put stents in renal (kidney) arteries?

Posted Nov 29 2009 10:01pm

People who have narrowings (plaque) in kidney blood vessels sometimes are referred for angioplasty and stenting to open up the blood vessels and improve blood flow to the kidneys. The kidneys help regulate blood pressure and when the kidney arteries get narrowed people can develop high blood pressure and kidney failure. I actually worked in an angiography lab for years where we performed balloon and stent procedures on renal arteries and had very good results. But does opening up the kidney blood vessels translate into health benefits? What do research studies say about renal artery procedures?

A 5-year study called the ASTRAL Study (published in the New England Journal of Medicine, Nov 2009) followed over 800 patients in the United Kingdom. Patients with renal artery stenosis (narrowings) were randomized to medications only or medications plus balloon angioplasty/stenting. Patients who received balloon angioplasty and medication therapy were found to have a slower progression of narrowings but no significant differences were observed in blood pressure or kidney blood work. Patients with severe narrowings leading to flash pulmonary edema (fluid in the lungs) or rapidly progressing kidney disease were not included in this study. So the health benefits in these patients are not known. But this study suggests that the routine use of balloon angioplasty and stenting for kidney artery narrowings is not recommended. Individual risks and benefits should be discussed with you physician to determine whether this procedure should be performed in addition to taking medications.

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