Original article Comparison of early and long-term impact of percutaneous transluminal renal artery angioplasty alone or with brachytherapy on renal function in patients with reno-vascular hypertension

Abstract

Background: Renal ischaemia resulting from stenosis of the renal artery may result in two important sequelae: systemic arterial hypertension, and renal atrophy and nephron loss, resulting in an increased risk of progression to end-stage renal disease. Renal artery stenosis (RAS) may lead to both renovascular hypertension and ischaemic nephropathy – a potentially curable cause of renal failure.
Aim: To assess the efficacy of g-intraluminal brachytherapy (ILBT) in prevention of restenosis after percutaneous transluminal renal artery angioplasty (PTRA) and the effects of this method of revascularisation on renal function.
Methods: 71 patients aged 52±8 years with refractory renovascular hypertension were randomised to group I (PTRA + ILBT) or group II (PTRA). Both baseline and 9-month follow-up angiography, intra-vascular ultrasound and non-invasive examination were performed to assess the efficacy of PTRA on renal function.
Results: The overall PTRA success rate was 87%: 33 patients from group I and 29 from group II underwent a successful procedure. A decrease of serum creatinine level was observed regardless of the treatment modality, directly after angioplasty: 20 µmol/l (17.5%) in group I and 26 µmol/l (22%) in group II (NS). Also in long-term follow-up this effect was sustained: 18 µmol/l (15.8%) in group I and 10 µmol/l (8.5%) in group II (NS). In the follow-up period a non-significant increase of serum creatinine level was observed in group I (from 94±19 to 96±25 µmol/l, NS). In group II the increase of serum creatinine level was significantly higher (from 92±39 µmol/l to 108±60 µmol/l, p=0.001).
Conclusions: PTRA improves renal function in patients with ischaemic nephropathy. In long-term observation the positive effect of PTRA on renal function is especially visible in patients with ILBT after PTRA.