Ischemic disease of the kidney: how and why to consider revascularization.
With increasingly accurate non-invasive tests, the clinician frequently discovers obstruction of the renal arteries by atherosclerosis. The decision to reverse this obstruction is not straightforward, particularly when blood pressure can be easily controlled with medications. Proper management of this problem requires knowledge of the accuracy of the diagnosis, the natural history of the disorder, and the outcomes of possible interventions. This review will emphasize the value of a variety of non-invasive tests, the consequences of allowing the arteries to remain obstructed, and the long-term results from reversing renal artery obstruction. Surgical and non-surgical interventions will be examined, including percutaneous angioplasty, angioplasty with wall stenting, surgical atherectomy, and surgical bypass procedures. In contemporary practice hypertension is routinely recognized and aggressively treated regardless of the etiology. Therefore preservation of kidney function is becoming an increasingly important clinical goal. This review will pursue a unified approach to renal artery obstruction and emphasize the goal of preserving glomerular filtration rate.
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