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Query: UMLS:C0034063 (pulmonary edema)
 10,665 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Renal artery stenosis (RAS) is a common condition associated with hypertension and renal insufficiency. The high prevalence of RAS patients with coronary and lower extremity vascular disease has been well established. Fibromuscular dysplasia in young females and atherosclerosis in patients over the age of 55 are the most common causes. Poorly controlled hypertension refractory to medical therapy, worsening of renal function, and flash pulmonary edema may point to underlying RAS. Duplex ultrasonography and magnetic resonance angiography have largely replaced captopril scanning for RAS screening. However, renal angiography still remains the gold standard to diagnose RAS. Treatment options include medical therapy, angioplasty, and surgery. In general, patients with a stenosis greater than 50%, a translesional systolic pressure gradient greater than 15 mm Hg, and difficult-to-control hypertension and/or worsening renal insufficiency are candidates for renal revascularization. Percutaneous transluminal revascularization has evolved to become the preferred revascularization therapy because it is a less invasive and more cost-effective alternative to surgery and is associated with high technical success, as well as a low complication rate. The natural history of RAS is to progress over time, leading to renal artery occlusion, loss of renal mass, worsening of renal function, and, ultimately, end-stage renal disease. It is therefore important to aggressively screen, recognize, and treat the entity early in its course.
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PMID:Current advances in the diagnosis and treatment of renal artery stenosis. 1558 Jan 59

Fibromuscular dysplasia (FMD) and aortoarteritis are the most frequent causes of secondary hypertension induced by renal artery stenosis (RAS). Revascularization of this disease entity usually cures arterial hypertension. Demographic evolution leads to an increasing incidence of atherosclerotic RAS, one of the major causes of end-stage renal failure. Furthermore, atherosclerotic RAS leads to deterioration of primary hypertension, progression of atherosclerosis manifestation such as occlusive and aneurysmatic peripheral artery disease, and chronic or acute organ damage such as left ventricular hypertrophy and recurrent flash pulmonary edema. Despite the lack of sufficiently powered randomized controlled trials, each hemodynamically relevant RAS (eg, > or = 70%) should be considered for stent angioplasty in patients without end-stage ischemic nephropathy or limited life expectancy due to concomitant disease (eg, cancer). Drug-eluting stents will probably reduce the overall low in-stent restenosis rate of 10% to 20%. Interventions in patients with dialysis-dependent end-stage nephropathy are left to appropriate clinical study protocols.
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PMID:Renal artery stenosis. 1748 11

A renal artery stenosis (RAS) is common among patients with atherosclerosis, up to a third of patients undergoing cardiac catheterization. Fibromuscular dysplasia is the next cause of RAS, commonly found in young women. Atherosclerosis RAS generally progresses overtime and is often associated with loss of renal mass and worsening renal function (RF). Percutaneous renal artery stent placement is the preferred method of revascularization for hemodynamically significant RAS according to ACC and AHA guidelines. Several randomized trials have shown the superiority of endovascular procedures to medical therapy alone. However, two studies ASTRAL and STAR studies were recently published and did not find any difference between renal stenting and medical therapy. But these studies have a lot of limitations and flaws as we will discuss (poor indications, poor results, numerous complications, failures, poor technique, inexperienced operators, ecc.). Despite these questionable studies, renal stenting keeps indications in patients with: uncontrolled hypertension; ischemic nephropathy; cardiac disturbance syndrome (e.g. "flash" pulmonary edema, uncontrolled heart failure or uncontrolled angina pectoris); solitary kidney. To improve the clinical response rates, a better selection of the patients and lesions is mandatory with: good non-invasive or invasive imaging; physiologic lesion assessment using transluminal pressure gradients; measurements of biomarkers (e.g., BNP); fractional flow reserve study. A problem remains after renal angioplasty stenting, the deterioration of the RF in 20-30% of the patients. Atheroembolism seems to play an important role and is probably the main cause of this R.F deterioration. The use of protection devices alone or in combination with IIb IIa inhibitors has been proposed and seems promising as shown in different recent reports. Renal angioplasty and stenting is still indicated but we need: a better patient and lesion selection; improvements in techniques and maybe the use of protection devices to reduce the risk of RF deterioration after renal stenting.
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PMID:Renal angioplasty and stenting: is it still indicated after ASTRAL and STAR studies? 2092 31