RAS Epidemiology. Renal Artery Stenosis. Pathophysiology of RAS. Disclosure of Potential Conflicts. Background Pathophysiology of RAS.

Save this PDF as:
 WORD  PNG  TXT  JPG

Size: px
Start display at page:

Download "RAS Epidemiology. Renal Artery Stenosis. Pathophysiology of RAS. Disclosure of Potential Conflicts. Background Pathophysiology of RAS."

Transcription

1 Renal Artery Stenosis RAS Epidemiology Common Disease Incidence General Population 0.1% Hypertensive Population 4% HTN & Suspected CAD 10-20% Malignant HTN 20-30% Malignant HTN and CKD 30-40% Alexander S. Yevzlin, MD Associate Professor of Medicine (CHS) ASDIN 2012 Prevalence increases with age: 7% over 65 years old Disclosure of Potential Conflicts Pathophysiology of RAS Cytopherx, Inc. R4 Vascular, Inc. Bard Peripheral Vascular Courtesy of V. Chhokar Background Road Map Defining the Controversy The Nephrologists Perspective A More Selective Approach Background Pathophysiology of RAS Other actions of angiotensin II (Ang II) promote pressor mechanisms, vascular remodeling, cardiac dysfunction, and tissue fibrosis. 1

2 Background Progression of Disease RAS > 50% Ischemic Nephropathy (no fibrosis resulting from hemodynamic changes) Ischemic Nephropathy RAS > 50% (small vessel disease) It is almost certain that many, if not most, patients now being subjected to endovascular stenting of the renal arteries have only limited benefit, regarding either BP response or improvement in kidney function. * * Levin a, Linas SL, Luft FC, Chapman AB, Textor SC: Controversies in renal artery stenosis: A review by the American Society of Nephrology Advisory Group on Hypertension. Am J Nephrol 27 : , The Controversy RAS Interventions Why Are Nephrologists Averse to Nephrologists have moved toward a more conservative clinical stance in recent years, perhaps as a pragmatic counterweight to enthusiastic interventional specialties. * The largest portion of this increase derives from procedures undertaken by cardiologists.* * Levin a, Linas SL, Luft FC, Chapman AB, Textor SC: Controversies in renal artery stenosis: A review by the American Society of Nephrology Advisory Group on Hypertension. Am J Nephrol 27 : , 2007 * Murphy TP, Soares G, Kim M: Increase in utilization of percutaneous renal artery interventions by Medicare beneficiaries Am J Roentgenol 183 : , 2004 The Controversy Several large randomized controlled trials (RCTs) have evaluated medical therapy versus PTRAS. The results of the STAR study showed no difference in progression of renal failure in patients with impaired renal function. This has been confirmed by the results of the ASTRAL study. Bax L, Woittiez AJ, Kouwenberg HJ, Mali WP, Buskens E, Beek FJ, et al. Stent placement in patients with atherosclerotic renal artery stenosis and impaired renal function: a randomized trial. Ann Intern Med 2009; 150: ; W Schwarzwalder U, Hauk M, Zeller T. RADAR: a randomised, multicentre, prospective study comparing best medical treatment versus best medical treatment plus renal artery stenting in patients with haemodynamically relevant atherosclerotic renal artery stenosis. Trials 2009; 10:60. Wheatley K, Ives N, Gray R, Kalra PA, Moss JG, Baigent C, et al. Revascularization versus medical therapy for renal-artery stenosis. N Engl J Med 2009; 361:

3 A possible explanation for the recent RAS clinical trial findings is that these studies included patients who had little chance to improve anyway. Fifteen years experience of treating Atherosclerotic Renal Artery Stenosis by Interventional Nephrologists in India Overall, the observational study by Hegde et al witnessed improvement in renal function in 10% and stabilization in 60% of the subjects. Estimated glomerular filtration rate (egfr) improved significantly in bilateral RAS, and egfr improved or stabilized in % of the subjects. The authors noted a > 90% technical success rate.how do these findings compare to existing observational studies? It is important to mention that such studies have reported mixed results vis-à-vis renal function. Why Are Nephrologists Averse to New Algorithm A recognized drawback of clinical treatment trials is the intermixture of high-risk and low-risk patients into the "average" of the entire cohort.* A definition of the RF associated with good and bad outcomes is necessary. * Kent D, Hayward R: When averages hide individual differences in clinical trials. Am Sci 95 : 60 68, 2007 Risk Factors for Outcomes Pre-intervention GFR Initial size of the treated kidney Vascular resistive index Patient age Lateralization to the affected kidney Otcomes Zeller T, Muller C, Frank U, Burgelin K, Horn B, Schwarzwalder U, et al. Stent angioplasty of severe atherosclerotic ostial renal artery stenosis in patients with diabetes mellitus and nephrosclerosis. Catheter Cardiovasc Interv 2003; 58: Radermacher J, Chavan A, Bleck J, Vitzthum A, Stoess B, Gebel MJ, et al. Use of Doppler ultrasonography to predict the outcome of therapy for renalartery stenosis. N Engl J Med 2001; 344: Krijnen P, van Jaarsveld BC, Deinum J, Steyerberg EW, Habbema JD. Which patients with hypertension and atherosclerotic renal artery stenosis benefit from immediate intervention? J Hum Hypertens 2004; 18: van Jaarsveld BC, Krijnen P, Pieterman H, Derkx FH, Deinum J, Postma CT, et al. The effect of balloon angioplasty on hypertension in atherosclerotic renal-artery stenosis. Dutch Renal Artery Stenosis Intervention Cooperative Study Group. N Engl J Med 2000; 342:

4 2/29/2012 Outcomes 4

5 Thank you 5

Life After CORAL: What Did CORAL Prove? David Paul Slovut, MD, PhD Co-director TAVR, Dir of Advanced Intervention

Life After CORAL: What Did CORAL Prove? David Paul Slovut, MD, PhD Co-director TAVR, Dir of Advanced Intervention Life After CORAL: What Did CORAL Prove? David Paul Slovut, MD, PhD Co-director TAVR, Dir of Advanced Intervention No Relationships to Disclose The Need for Modern Renal Trials Increased rate of RAS diagnosis

More information

Coral Trials: A personal experience that challenges its results in patients with uncontrolled blood pressure.

Coral Trials: A personal experience that challenges its results in patients with uncontrolled blood pressure. Coral Trials: A personal experience that challenges its results in patients with uncontrolled blood pressure.. Dr. Javier Ruiz Aburto, FACS, FICS Assistant Professor Ponce School of Medicine Puerto Rico

More information

Atherosclerotic renal artery stenosis and reconstruction

Atherosclerotic renal artery stenosis and reconstruction http://www.kidney-international.org & 2006 International Society of Nephrology mini review Atherosclerotic renal artery stenosis and reconstruction B Krumme 1 and J Donauer 2 1 Deutsche Klinik für Diagnostik,

More information

Angioplasty with stent in renal artery stenosis: our experience

Angioplasty with stent in renal artery stenosis: our experience Rev Chil Radiol 2016; 22(1): 13-19. Angioplasty with stent in renal artery stenosis: our experience Johanna Marcela Vasquez Veloza *, José Luis Abades Vázquez, José Luis Cordero Castro. Interventional

More information

Renal artery stenosis, defined as a narrowing

Renal artery stenosis, defined as a narrowing IN THE LITERATURE Is There Any Reason to Stent Atherosclerotic Renal Artery Stenosis? Commentary on ASTRAL Investigators. Revascularization versus medical therapy for renal artery stenosis. N Engl J Med.

More information

Predicting blood pressure response after renal artery stenting

Predicting blood pressure response after renal artery stenting From the Southern Association for Vascular Surgery Predicting blood pressure response after renal artery stenting Adam W. Beck, MD, a Brian W. Nolan, MD, a,b Randall De Martino, MD, a Theodore H. Yuo,

More information

Renal Artery Stenosis: New View on a Difficult Clinical Problem

Renal Artery Stenosis: New View on a Difficult Clinical Problem 26 31 August, 2013 The 20th Budapest Nephrology School Nephrology, Hypertension, Dialysis, Transplantation Renal Artery Stenosis: New View on a Difficult Clinical Problem Prof. Andrzej Wiecek Department

More information

Controversies in the management of the renal artery stenosis

Controversies in the management of the renal artery stenosis REVIEW ARTICLE Cardiology Journal 2013, Vol. 20, No. 1, pp. 11 16 10.5603/CJ.2013.0003 Copyright 2013 Via Medica ISSN 1897 5593 Controversies in the management of the renal artery stenosis Khalil Kanjwal

More information

RENAL ARTERY PTA. JH PEREGRIN IKEM, Prague

RENAL ARTERY PTA. JH PEREGRIN IKEM, Prague RENAL ARTERY PTA JH PEREGRIN IKEM, Prague PTRA/Stenting PTRA technical success rate > 90 % In some patients helps control hypertension In some patients can improve kidney function Serious complications

More information

Michael Meuse, M.D. Vascular and Interventional Radiology

Michael Meuse, M.D. Vascular and Interventional Radiology Michael Meuse, M.D. Vascular and Interventional Radiology Which patient would likely benefit from renal artery revascularization? Patient A- 60 y/o male with 20 year hx of htn; on 2 drug therapy for 10

More information

Revascularization versus Medical Therapy for Renal-Artery Stenosis

Revascularization versus Medical Therapy for Renal-Artery Stenosis The new england journal of medicine original article versus Medical Therapy for Renal-Artery Stenosis The ASTRAL Investigators* Abstract Background Percutaneous revascularization of the renal arteries

More information

Clinical Medicine Insights: Cardiology

Clinical Medicine Insights: Cardiology Clinical Medicine Insights: Cardiology Original Research Open Access Full open access to this and thousands of other papers at http://www.la-press.com. Relationship between Distribution of Coronary Artery

More information

Renal Artery Stenting Associated With Improvement in Renal Function and Blood Pressure Control in Long-Term Follow-Up

Renal Artery Stenting Associated With Improvement in Renal Function and Blood Pressure Control in Long-Term Follow-Up 2016 The Author(s). 2016 Published The Author(s) by S. Karger AG, Basel www.karger.com/kbr Published by S. Karger AG, Basel 278 1423-0143/16/0413-0278$39.50/0 Accepted: February 08, 2016 www.karger.com/kbr

More information

Diagnosis of Renal Artery Stenosis (RAS)

Diagnosis of Renal Artery Stenosis (RAS) May 2001 Diagnosis of Renal Artery Stenosis (RAS) Kurt Fink, Harvard Medical School, Year III Epidemiology Hypertension -Affects 60 million Americans Essential HTN >95% of cases Secondary HTN 1-5% of cases

More information

The New England Journal of Medicine USE OF DOPPLER ULTRASONOGRAPHY TO PREDICT THE OUTCOME OF THERAPY FOR RENAL-ARTERY STENOSIS

The New England Journal of Medicine USE OF DOPPLER ULTRASONOGRAPHY TO PREDICT THE OUTCOME OF THERAPY FOR RENAL-ARTERY STENOSIS USE OF DOPPLER ULTRASONOGRAPHY TO PREDICT THE OUTCOME OF THERAPY FOR RENAL-ARTERY STENOSIS JÖRG RADERMACHER, M.D., AJAY CHAVAN, M.D., JÖRG BLECK, M.D., ANNABEL VITZTHUM, BIRTE STOESS, MICHAEL JAN GEBEL,

More information

Atherosclerotic renovascular disease

Atherosclerotic renovascular disease Cardiology 69 Atherosclerotic renal artery stenosis Atherosclerotic renal artery stenosis is largely a disease of the elderly and is commonly associated with hypertension and renal dysfunction. Blood pressure

More information

Renal PEI: critical appraisal

Renal PEI: critical appraisal Renal PEI: critical appraisal On Topaz M.D., F.A.C.C.,F.S.V.M. Professor of Medicine & Pathology Director, Interventional Cardiology McGuire Veterans Medical Center Virginia Commonwealth University Richmond,

More information

Original Studies. Catheterization and Cardiovascular Interventions 00: (2012)

Original Studies. Catheterization and Cardiovascular Interventions 00: (2012) Catheterization and Cardiovascular Interventions 00:000 000 (2012) Original Studies Significant Reduction in Systolic Blood Pressure Following Renal Artery Stenting in Patients With Uncontrolled Hypertension:

More information

Renal Artery Stenosis Current Management Perspectives

Renal Artery Stenosis Current Management Perspectives 128 Medicine Update 23 Renal Artery Stenosis Current Management Perspectives NN KHANNA, K ROSHAN RAO, SARITA YADAV RAO, SANGEETA KHANNA INTRODUCTION Renal artery stenosis (RAS) is often overlooked and

More information

Chapter 2: Identification and Care of Patients With Chronic Kidney Disease

Chapter 2: Identification and Care of Patients With Chronic Kidney Disease Chapter 2: Identification and Care of Patients With Chronic Kidney Disease Introduction The examination of care in patients with chronic kidney disease (CKD) is a significant challenge, as most large datasets

More information

Catheter-Based Renal Denervation Reduces Total Body and Renal Noradrenaline Spillover and Blood Pressure in Resistant Hypertension

Catheter-Based Renal Denervation Reduces Total Body and Renal Noradrenaline Spillover and Blood Pressure in Resistant Hypertension Catheter-Based Renal Denervation Reduces Total Body and Renal Noradrenaline Spillover and Blood Pressure in Resistant Hypertension Murray Esler, Markus Schlaich, Paul Sobotka, Rob Whitbourn, Jerzy Sadowski,

More information

Interventional Cardiology

Interventional Cardiology nal Review Interventional Cardiology Selecting patients likely to benefit from renal artery stenting Patients with refractory hypertension, progressive ischemic nephropathy and cardiac destabilization

More information

The role of percutaneous revascularization for renal artery stenosis

The role of percutaneous revascularization for renal artery stenosis The role of percutaneous revascularization for renal artery stenosis Gregory J Dubel and Timothy P Murphy Abstract: Renal artery stenosis (RAS) is usually caused by atherosclerosis or fibromuscular dysplasia.

More information

Renal artery revascularization: Outcomes stratified by indication for intervention

Renal artery revascularization: Outcomes stratified by indication for intervention Renal artery revascularization: Outcomes stratified by indication for intervention Virendra I. Patel, MD, Mark F. Conrad, MD, Christopher J. Kwolek, MD, Glenn M. LaMuraglia, MD, Thomas K. Chung, MS, and

More information

Restenosis after renal artery angioplasty and stenting: Incidence and risk factors

Restenosis after renal artery angioplasty and stenting: Incidence and risk factors From the Southern Association for Vascular Surgery Restenosis after renal artery angioplasty and stenting: Incidence and risk factors Matthew A. Corriere, MD, MS, a Matthew S. Edwards, MD, MS, a Jeffrey

More information

Role of interventions for atherosclerotic renal artery stenoses

Role of interventions for atherosclerotic renal artery stenoses TRANS-ATLANTIC DEBATE Thomas L. Forbes, MD, and Jean-Baptiste Ricco, MD, PhD, Section Editors Role of interventions for atherosclerotic renal artery stenoses Vikram S. Kashyap, MD, a Fabrice Schneider,

More information

Immediate Normalisation of Blood Pressure following Intervention in Functional Total Occlusion of Unilateral Renal Artery with an Atrophic Kidney

Immediate Normalisation of Blood Pressure following Intervention in Functional Total Occlusion of Unilateral Renal Artery with an Atrophic Kidney Immediate Normalisation of Blood Pressure following Intervention in Functional Total Occlusion of Unilateral Renal Artery with an Atrophic Kidney Dr Parminder Singh Otaal Assistant Professor Department

More information

Clinical bene t of renal artery angioplasty with stenting for the control of recurrent and refractory congestive heart failure

Clinical bene t of renal artery angioplasty with stenting for the control of recurrent and refractory congestive heart failure Clinical bene t of renal artery angioplasty with stenting for the control of recurrent and refractory congestive heart failure Bruce H Gray a, Jeffrey W Olin b, Mary Beth Childs c, Timothy M Sullivan d

More information

Contrast Induced Nephropathy

Contrast Induced Nephropathy Contrast Induced Nephropathy O CIAKI refers to an abrupt deterioration in renal function associated with the administration of iodinated contrast media O CIAKI is characterized by an acute (within 48 hours)

More information

Daniela Branzan MD, Department of Vascular Surgery and Department of Interventional Angiology University Hospital Leipzig

Daniela Branzan MD, Department of Vascular Surgery and Department of Interventional Angiology University Hospital Leipzig Ischemic Preconditioning with Minimally Invasive Segmental Artery Coil Embolization (MISACE) prior to Endovascular TAAA Repair: Clinical Experience in 50+ Patients Daniela Branzan MD, Department of Vascular

More information

Changes in Guideline Trends and Applications in Practice: JNC 2013

Changes in Guideline Trends and Applications in Practice: JNC 2013 Changes in Guideline Trends and Applications in Practice: JNC 2013 George L. Bakris, MD, FAHA, FASN Professor of Medicine Director of the ASH Hypertension Center The University of Chicago Medicine Chicago,

More information

Objectives. Pre-dialysis CKD: The Problem. Pre-dialysis CKD: The Problem. Objectives

Objectives. Pre-dialysis CKD: The Problem. Pre-dialysis CKD: The Problem. Objectives The Role of the Primary Physician and the Nephrologist in the Management of Chronic Kidney Disease () By Brian Young, M.D. Assistant Clinical Professor of Medicine David Geffen School of Medicine at UCLA

More information

Effect of renal artery revascularization on left ventricular hypertrophy, diastolic function, blood pressure, and the one-year outcome

Effect of renal artery revascularization on left ventricular hypertrophy, diastolic function, blood pressure, and the one-year outcome Effect of renal artery revascularization on left ventricular hypertrophy, diastolic function, blood pressure, and the one-year outcome Daniel Rzeznik, MD, Tadeusz Przewlocki, MD, PhD, Anna Kablak-Ziembicka,

More information

Blood Pressure Monitoring in Chronic Kidney Disease

Blood Pressure Monitoring in Chronic Kidney Disease Blood Pressure Monitoring in Chronic Kidney Disease Aldo J. Peixoto, MD FASN FASH Associate Professor of Medicine (Nephrology), YSM Associate Chief of Medicine, VACT Director of Hypertension, VACT American

More information

Incidence and Prevalence of Atherosclerotic Renal Artery Stenosis (RAS) in Patients with Coronary Artery Disease (CAD)

Incidence and Prevalence of Atherosclerotic Renal Artery Stenosis (RAS) in Patients with Coronary Artery Disease (CAD) Incidence and Prevalence of Atherosclerotic Renal Artery Stenosis (RAS) in Patients with Coronary Artery Disease (CAD) AHMW Islam, S Munwar, S Talukder, AQM Reza Dept. of Invasive & Interventional Cardiology,

More information

Practical Cases in Hypertension Management Management of Secondary Hypertension

Practical Cases in Hypertension Management Management of Secondary Hypertension Practical Cases in Hypertension Management Management of Secondary Hypertension 2011. 04.16. 가톨릭의과대학순환기내과임상현 FREQUENCY OF VARIOUS DIAGNOSES IN HYPERTENSIVE PATIENTS 1980s PRIMARY CARE REFERRAL Essential

More information

Chapter 2: Identification and Care of Patients With CKD

Chapter 2: Identification and Care of Patients With CKD Chapter 2: Identification and Care of Patients With Over half of patients from the Medicare 5% sample (restricted to age 65 and older) have a diagnosis of chronic kidney disease (), cardiovascular disease,

More information

Approach to atherosclerotic renovascular disease: 2016

Approach to atherosclerotic renovascular disease: 2016 Washington University School of Medicine Digital Commons@Becker Open Access Publications 2016 Approach to atherosclerotic renovascular disease: 2016 Reem Daloul Washington University School of Medicine

More information

Cardiovascular Disease in CKD. Parham Eftekhari, D.O., M.Sc. Assistant Clinical Professor Medicine NSUCOM / Broward General Medical Center

Cardiovascular Disease in CKD. Parham Eftekhari, D.O., M.Sc. Assistant Clinical Professor Medicine NSUCOM / Broward General Medical Center Cardiovascular Disease in CKD Parham Eftekhari, D.O., M.Sc. Assistant Clinical Professor Medicine NSUCOM / Broward General Medical Center Objectives Describe prevalence for cardiovascular disease in CKD

More information

Alan Jay Block, DPM, MS, FASPS, FACFAS Co-Chair My Leg My Choice Medical Advisory Board Kent State University Editor in Chief Journal of the American

Alan Jay Block, DPM, MS, FASPS, FACFAS Co-Chair My Leg My Choice Medical Advisory Board Kent State University Editor in Chief Journal of the American ` Alan Jay Block, DPM, MS, FASPS, FACFAS Co-Chair My Leg My Choice Medical Advisory Board Kent State University Editor in Chief Journal of the American Society of Podiatric Surgeons Adj. Assistant Professor

More information

FULFILLMENT OF K/DOQI GUIDELINES 92 anemia treatment dialysis therapy vascular access

FULFILLMENT OF K/DOQI GUIDELINES 92 anemia treatment dialysis therapy vascular access INTRODUCTION ANEMIA TREATMENT hemoglobin levels epo treatment iron treatment FULFILLMENT OF K/DOQI GUIDELINES 2 anemia treatment dialysis therapy vascular access EPO DOSING PATTERNS 4 epo dosing per kg

More information

RANGER SFA REGISTRY Interim Analysis. Bernd Gehringhoff, MD On behalf the Ranger SFA Registry Investigators

RANGER SFA REGISTRY Interim Analysis. Bernd Gehringhoff, MD On behalf the Ranger SFA Registry Investigators RANGER SFA REGISTRY Interim Analysis Bernd Gehringhoff, MD On behalf the Ranger SFA Registry Investigators Conflict of Interest - Disclosure Within the past 12 months, I or my spouse/partner have had a

More information

Diabetic Kidney Disease Tripti Singh MD Department of Nephrology University of Wisconsin

Diabetic Kidney Disease Tripti Singh MD Department of Nephrology University of Wisconsin Diabetic Kidney Disease Tripti Singh MD Department of Nephrology University of Wisconsin Disclosures I have no financial relationship with the manufacturers of any commercial product discussed during this

More information

KDIGO Controversies Conference on Challenges in the Conduct of Clinical Trials in Nephrology

KDIGO Controversies Conference on Challenges in the Conduct of Clinical Trials in Nephrology KDIGO Controversies Conference on Challenges in the Conduct of Clinical Trials in Nephrology September 8-11, 2016 Paris, France Kidney Disease: Improving Global Outcomes (KDIGO) is an international organization

More information

Dilemmas in the management of renal artery stenosis

Dilemmas in the management of renal artery stenosis Dilemmas in the management of renal artery stenosis Ching M. Cheung, Janet Hegarty and Philip A. Kalra* Department of Renal Medicine, Hope Hospital, Stott Lane, Salford M6 8HD, UK Atherosclerotic renovascular

More information

Consensus Core Set: Cardiovascular Measures Version 1.0

Consensus Core Set: Cardiovascular Measures Version 1.0 Consensus Core Set: Cardiovascular s NQF 0330 Hospital 30-day, all-cause, riskstandardized readmission rate (RSRR) following heart failure hospitalization 0229 Hospital 30-day, all-cause, riskstandardized

More information

Hybrid Coronary Revascularization: An Evolving Paradigm

Hybrid Coronary Revascularization: An Evolving Paradigm Hybrid Coronary Revascularization: An Evolving Paradigm From Meta-analysis to the NIH Multicenter Observational and Randomized Studies John D. Puskas, MD Chairman, Cardiovascular Surgery, Mount Sinai Saint

More information

Minimally Invasive Treatment Options for Renal Artery FMD

Minimally Invasive Treatment Options for Renal Artery FMD Minimally Invasive Treatment Options for Renal Artery FMD FMDSA Meeting 2016 Alan H. Matsumoto, M.D., FSIR, FACR, FAHA Professor and Chair Department of Radiology & Medical Imaging University of Virginia

More information

Peripheral Arterial Disease. Definition 4/9/2015. Prevalence of PAD. Arash Karnama, DO, FACC Oklahoma Heart Institute

Peripheral Arterial Disease. Definition 4/9/2015. Prevalence of PAD. Arash Karnama, DO, FACC Oklahoma Heart Institute Peripheral Arterial Disease Arash Karnama, DO, FACC Oklahoma Heart Institute Definition Most commonly secondary to atherosclerosis (plaque) affecting arteries supplying head, organs, and limbs. Prevalence

More information

Renal function and outcome of PTRA and stenting for atherosclerotic renal artery stenosis

Renal function and outcome of PTRA and stenting for atherosclerotic renal artery stenosis Kidney International, Vol. 63 (2003), pp. 276 282 Renal function and outcome of PTRA and stenting for atherosclerotic renal artery stenosis FELIPE RAMOS, CAROL KOTLIAR, DANIEL ALVAREZ, HUGO BAGLIVO, PABLO

More information

AJNT. Case report. Restoration of Kidney Function after Prolonged (Four Months) Anuria Due to Bilateral Renal Artery Occlusion

AJNT. Case report. Restoration of Kidney Function after Prolonged (Four Months) Anuria Due to Bilateral Renal Artery Occlusion Case report AJNT Restoration of Kidney Function after Prolonged (Four Months) Anuria Due to Bilateral Renal Artery Occlusion Abdul-Rahman A El-Magzoub a*, Sarra Elamin b a. MRCP, MSc nephrology (Sheffield),

More information

Diagnosis and management of atherosclerotic renal artery stenosis: improving patient selection and outcomes

Diagnosis and management of atherosclerotic renal artery stenosis: improving patient selection and outcomes Diagnosis and management of atherosclerotic renal artery stenosis: improving patient selection and outcomes Christopher J White* and Jeffrey W Olin SuMMarY Renal artery stenosis (RAS) is common among patients

More information

Chapter 5: Acute Kidney Injury

Chapter 5: Acute Kidney Injury Chapter 5: Acute Kidney Injury In 2015, 4.3% of Medicare fee-for-service beneficiaries experienced a hospitalization complicated by Acute Kidney Injury (AKI); this appears to have plateaued since 2011

More information

Outline. Outline CHRONIC KIDNEY DISEASE UPDATE: WHAT THE GENERALIST NEEDS TO KNOW 7/23/2013. Question 1: Which of these patients has CKD?

Outline. Outline CHRONIC KIDNEY DISEASE UPDATE: WHAT THE GENERALIST NEEDS TO KNOW 7/23/2013. Question 1: Which of these patients has CKD? CHRONIC KIDNEY DISEASE UPDATE: WHAT THE GENERALIST NEEDS TO KNOW MICHAEL G. SHLIPAK, MD, MPH CHIEF-GENERAL INTERNAL MEDICINE, SAN FRANCISCO VA MEDICAL CENTER PROFESSOR OF MEDICINE, EPIDEMIOLOGY AND BIOSTATISTICS,

More information

Left ventricular hypertrophy: why does it happen?

Left ventricular hypertrophy: why does it happen? Nephrol Dial Transplant (2003) 18 [Suppl 8]: viii2 viii6 DOI: 10.1093/ndt/gfg1083 Left ventricular hypertrophy: why does it happen? Gerard M. London Department of Nephrology and Dialysis, Manhes Hospital,

More information

Dr. Murty Mantha MD FRACP Cairns Base Hospital Cairns. DNT 2011 Hunter Valley

Dr. Murty Mantha MD FRACP Cairns Base Hospital Cairns. DNT 2011 Hunter Valley Dr. Murty Mantha MD FRACP Cairns Base Hospital Cairns DNT 2011 Hunter Valley Approximately 45% of AVF are functional without intervention after creation The procedure rate is 1.45-3.3 procedures/avf

More information

The major issues in approaching patients with renal artery stenosis

The major issues in approaching patients with renal artery stenosis Renovascular Hypertension and Ischemic Nephropathy Marc A. Pohl The major issues in approaching patients with renal artery stenosis relate to the role of renal artery stenosis in the management of hypertension,

More information

Mid-term results of 300+ patients treated by endovascular aortic sealing (EVAS)

Mid-term results of 300+ patients treated by endovascular aortic sealing (EVAS) Mid-term results of 300+ patients treated by endovascular aortic sealing (EVAS) Jean-Paul P.M. de Vries Dept Vascular Surgery St. Antonius Hospital, Nieuwegein,The Netherlands On behalf of the DEVASS study

More information

Duplex Ultrasound of the Renal Arteries. Duplex Ultrasound. In the Beginning

Duplex Ultrasound of the Renal Arteries. Duplex Ultrasound. In the Beginning Duplex Ultrasound of the Renal Arteries DIMENSIONS IN HEART AND VASCULAR CARE 2013 PENN STATE HEART AND VASCULAR INSTITUTE ROBERT G. ATNIP MD PROFESSOR OF SURGERY AND RADIOLOGY Duplex Ultrasound Developed

More information

CKD in the United States: An Overview of the USRDS Annual Data Report, Volume 1

CKD in the United States: An Overview of the USRDS Annual Data Report, Volume 1 CKD in the United States: An Overview of the USRDS Annual Data Report, Volume 1 Introduction Chronic kidney disease (CKD) has received significant attention over the last decade, primarily since the consensus

More information

NEPHROLOGIST JACK WATERMAN DO FACOI

NEPHROLOGIST JACK WATERMAN DO FACOI NEPHROLOGIST JACK WATERMAN DO FACOI ANYTHING NEW? JACK WATERMAN DO FACOI NOT REALLY ANATOMY/PHYSIOLOGY DIAGNOSTIC TOOLS EPIDEMIOLOGY AND CLINICAL PRESENTATION TREATMENT OPTIONS CLINICAL TRIALS CONFUSED

More information

Protocol for iv. iodine and gadolinium contrast studies

Protocol for iv. iodine and gadolinium contrast studies Protocol for iv. iodine and gadolinium contrast studies Royal College of Radiologists Standard The individual administering the contrast agent must ensure that the patient understands that it is to be

More information

Brachytherapy for In-Stent Restenosis: Is the Concept Still Alive? Matthew T. Menard, M.D. Brigham and Women s Hospital Boston, Massachussetts

Brachytherapy for In-Stent Restenosis: Is the Concept Still Alive? Matthew T. Menard, M.D. Brigham and Women s Hospital Boston, Massachussetts Brachytherapy for In-Stent Restenosis: Is the Concept Still Alive? Matthew T. Menard, M.D. Brigham and Women s Hospital Boston, Massachussetts Disclosure Speaker name: Matthew T. Menard... x I do not have

More information

Use of Laser In BTK Disease (CLI)

Use of Laser In BTK Disease (CLI) Use of Laser In BTK Disease (CLI) Click to edit academic affiliation, practice or hospital logo(s) of preference. Product and/or sponsor logos not permitted, per CME guidelines. Richard Kovach, MD, FACC,

More information

VALUE OF ACEI IN THE MANAGEMENT OF HYPERTENSION

VALUE OF ACEI IN THE MANAGEMENT OF HYPERTENSION VALUE OF ACEI IN THE MANAGEMENT OF HYPERTENSION Dr Catherine BESEME Paris 6 th December 2005 6 th International Congress of Bangladesh Society of Medicine Hypertension is a risk factor at the source, with

More information

TRENDS IN RENAL REPLACEMENT THERAPY IN BOSNIA AND HERZEGOVINA

TRENDS IN RENAL REPLACEMENT THERAPY IN BOSNIA AND HERZEGOVINA & TRENDS IN RENAL REPLACEMENT THERAPY IN BOSNIA AND HERZEGOVINA 2002-2008 Halima Resić* 1, Enisa Mešić 2 1 Clinic for Hemodialysis, University of Sarajevo Clinics Centre, Bolnička 25, 71000 Sarajevo, Bosnia

More information

Renal Denervation. Henry Krum MBBS PhD FRACP. Centre of Cardiovascular Research & Monash University/Alfred Hospital;

Renal Denervation. Henry Krum MBBS PhD FRACP. Centre of Cardiovascular Research & Monash University/Alfred Hospital; Renal Denervation Henry Krum MBBS PhD FRACP Centre of Cardiovascular Research & Education in Therapeutics, Monash University/Alfred Hospital; Alfred Heart Centre, The Alfred Hospital, Melbourne Australia

More information

Ischemic nephropathy. Review article. Anupama Kaul a, *, Harsh Vardhan b. 1. Introduction. Available online at

Ischemic nephropathy. Review article. Anupama Kaul a, *, Harsh Vardhan b. 1. Introduction. Available online at clinical queries: nephrology 1 (2012) 268e278 Available online at www.sciencedirect.com journal homepage: www.elsevier.com/locate/cqn Review article Ischemic nephropathy Anupama Kaul a, *, Harsh Vardhan

More information

Coronary Artery Revascularization in the Non-Infarct Artery During STEMI

Coronary Artery Revascularization in the Non-Infarct Artery During STEMI Is There Sufficient Evidence To Discourage The Use Of Multi-Vessel Angioplasty During STEMI? Konstantinos Dean Boudoulas, MD Assistant Professor of Internal Medicine Division of Cardiovascular Medicine

More information

GORE VIABAHN Device for Arteriovenous Access (Revision) Speaker Slideset

GORE VIABAHN Device for Arteriovenous Access (Revision) Speaker Slideset GORE VIABAHN Device for Arteriovenous Access (Revision) Speaker Slideset Restenosis can Occur within Minutes or Hours After a Successful Angioplasty A Severe stenosis of cephalic vein B Good result immediately

More information

Percutaneous Renal Denervation: A New Promise in the Treatment of RHT?

Percutaneous Renal Denervation: A New Promise in the Treatment of RHT? BAD KROZINGEN Prof. T. Zeller, MD Bad Krozingen, Germany Percutaneous Renal Denervation: A New Promise in the Treatment of RHT? Potential conflicts of interest Speaker s name: Thomas Zeller X I have the

More information

Atherosclerotic Renal Artery Stenosis

Atherosclerotic Renal Artery Stenosis Atherosclerotic Renal Artery Stenosis When is open surgical reconstruction the best treatment option? BY THOMAS A. ABBRUZZESE, MD, AND RICHARD P. CAMBRIA, MD Atherosclerotic disease is the most common

More information

The CARI Guidelines Caring for Australians with Renal Impairment. Specific effects of calcium channel blockers in diabetic nephropathy GUIDELINES

The CARI Guidelines Caring for Australians with Renal Impairment. Specific effects of calcium channel blockers in diabetic nephropathy GUIDELINES Specific effects of calcium channel blockers in diabetic nephropathy Date written: September 2004 Final submission: September 2005 Author: Kathy Nicholls GUIDELINES a. Non-dihydropyridine calcium channel

More information

Chronic Kidney Disease: Optimal and Coordinated Management

Chronic Kidney Disease: Optimal and Coordinated Management Chronic Kidney Disease: Optimal and Coordinated Management Michael Copland, MD, FRCPC Presented at University of British Columbia s 42nd Annual Post Graduate Review in Family Medicine Conference, Vancouver,

More information

Percutaneous and Surgical Treatments

Percutaneous and Surgical Treatments AVG Pseudoaneurysms Percutaneous and Surgical Treatments Marius Florescu M.D. Feb. 2015 ASDIN DEFINITION AVG Pseudoaneurysm Formation Incidence AVG Pseudoaneurysm incidence rate ranges between 2% and 10%

More information

Diabetes and renal disease: who does what?

Diabetes and renal disease: who does what? CLINICAL PRACTICE Clinical Medicine 2013, Vol 13, No 5: 460 4 Diabetes and renal disease: who does what? Ruth K Jones, David Hampton, Daniel J O Sullivan and Aled O Phillips ABSTRACT Care of patients with

More information

The Cardiorenal Syndrome in Heart Failure

The Cardiorenal Syndrome in Heart Failure The Cardiorenal Syndrome in Heart Failure Van N Selby, MD Assistant Professor of Medicine Advanced Heart Failure Program, UCSF October 9, 2015 Disclosures None 1 Cardiorenal Syndrome (CRS) A pathophysiologic

More information

JVA ISSN Hemodialysis vascular access management in the Netherlands. Introduction ORIGINAL ARTICLE

JVA ISSN Hemodialysis vascular access management in the Netherlands. Introduction ORIGINAL ARTICLE JVA ISSN 1129-7298 J Vasc Access 2015; 16 (Suppl 9): S11-S15 DOI: 10.5301/jva.5000366 ORIGINAL ARTICLE Hemodialysis vascular access management in the Netherlands Jan H.M. Tordoir 1, Magda M. van Loon 1,

More information

Salt Sensitivity: Mechanisms, Diagnosis, and Clinical Relevance

Salt Sensitivity: Mechanisms, Diagnosis, and Clinical Relevance Salt Sensitivity: Mechanisms, Diagnosis, and Clinical Relevance Matthew R. Weir, MD Professor and Director Division of Nephrology University of Maryland School of Medicine Overview Introduction Mechanisms

More information

Volume Management 2/25/2017. Disclosures statement: Objectives. To discuss evaluation of hypervolemia in peritoneal dialysis patients

Volume Management 2/25/2017. Disclosures statement: Objectives. To discuss evaluation of hypervolemia in peritoneal dialysis patients Volume Management Sagar Nigwekar MD, MMSc Massachusetts General Hospital E-mail: snigwekar@mgh.harvard.edu March 14, 2017 Disclosures statement: Consultant: Allena, Becker Professional Education Grant

More information

On Renal Artery Stenosis

On Renal Artery Stenosis On Renal Artery Stenosis by Hampus Eklöf Uppsala 2005 Book design and layout Håkan Pettersson, Uppsala University Department of Oncology, Radiology and Clinical Immunology Section of Radiology Akademiska

More information

Study population Patients with intermittent claudication or critical ischaemia due to an iliac arterial stenosis.

Study population Patients with intermittent claudication or critical ischaemia due to an iliac arterial stenosis. Iliac arterial occlusive disease: cost-effectiveness analysis of stent placement versus percutaneous transluminal angioplasty Bosch J L, Tetteroo E, Mali W P, Hunink M G Record Status This is a critical

More information

CAROTID ARTERY ANGIOPLASTY

CAROTID ARTERY ANGIOPLASTY CAROTID ARTERY ANGIOPLASTY Coverage for services, procedures, medical devices and drugs are dependent upon benefit eligibility as outlined in the member's specific benefit plan. This Medical Coverage Guideline

More information

Chronic Pediatric Hypertension

Chronic Pediatric Hypertension Chronic Pediatric Hypertension Nephrology Grand Round 3/13/2015 Mahmoud Kallash M.D Outline Definition of hypertension (HTN) Challenges in diagnosing HTN Epidemiology Causes and evaluation of HTN Management

More information

A: Epidemiology update. Evidence that LDL-C and CRP identify different high-risk groups

A: Epidemiology update. Evidence that LDL-C and CRP identify different high-risk groups A: Epidemiology update Evidence that LDL-C and CRP identify different high-risk groups Women (n = 27,939; mean age 54.7 years) who were free of symptomatic cardiovascular (CV) disease at baseline were

More information

Instantaneous Wave-Free Ratio

Instantaneous Wave-Free Ratio Instantaneous Wave-Free Ratio Alejandro Aquino MD Interventional Cardiology Fellow Washington University in St. Louis Barnes-Jewish Hospital Instantaneous Wave-Free Ratio Alejandro Aquino MD Disclosure

More information

Role of Covered Stents and Drug Eluting Balloons In Dialysis Access

Role of Covered Stents and Drug Eluting Balloons In Dialysis Access Role of Covered Stents and Drug Eluting Balloons In Dialysis Access Joseph Habib, MD, FACS Assistant Professor Department of Surgery Division of Vascular and Endovascular Surgery University of Florida

More information

Primary Care Physicians and Clinicians. XXX on behalf of the Upper Midwest Fistula First Coalition. Chronic Kidney Disease (CKD) Resources

Primary Care Physicians and Clinicians. XXX on behalf of the Upper Midwest Fistula First Coalition. Chronic Kidney Disease (CKD) Resources August 10, 2007 To: From: RE: Primary Care Physicians and Clinicians XXX on behalf of the Upper Midwest Fistula First Coalition Chronic Kidney Disease (CKD) Resources Caring for patients with chronic kidney

More information

OPEN ACCESS TEXTBOOK OF GENERAL SURGERY

OPEN ACCESS TEXTBOOK OF GENERAL SURGERY OPEN ACCESS TEXTBOOK OF GENERAL SURGERY RENOVASCULAR HYPERTENSION NG Naidoo BASIC CONSIDERATIONS Renovascular hypertension (RVH) is defined as any vascular pathology that produces hypoperfusion of the

More information

Le# main treatment with Stentys stent. Carlo Briguori, MD, PhD Clinica Mediterranea Naples, Italy

Le# main treatment with Stentys stent. Carlo Briguori, MD, PhD Clinica Mediterranea Naples, Italy Le# main treatment with Stentys stent Carlo Briguori, MD, PhD Clinica Mediterranea Naples, Italy Disclosure Statement of Financial Interest I, Carlo Briguori DO NOT have a financial interest/ arrangement

More information

Medical Information on Renal Arterial Stenting

Medical Information on Renal Arterial Stenting 24 Sharma R: Medical Information on Renal Arterial Stenting Review Paper Medical Information on Renal Arterial Stenting Rakesh Sharma Abstract. Renal artery stenosis (RAS) is a common pathological condition

More information

Chapter 5: Acute Kidney Injury

Chapter 5: Acute Kidney Injury Chapter 5: Acute Kidney Injury Introduction In recent years, acute kidney injury (AKI) has gained increasing recognition as a major risk factor for the development of chronic kidney disease (CKD). The

More information

PRIMARY PHASE 2 ANALYSES FROM CARDINAL: A PHASE 2/3 STUDY OF BARDOXOLONE METHYL IN PATIENTS WITH ALPORT SYNDROME

PRIMARY PHASE 2 ANALYSES FROM CARDINAL: A PHASE 2/3 STUDY OF BARDOXOLONE METHYL IN PATIENTS WITH ALPORT SYNDROME PRIMARY PHASE 2 ANALYSES FROM CARDINAL: A PHASE 2/3 STUDY OF BARDOXOLONE METHYL IN PATIENTS WITH ALPORT SYNDROME 217 American Society of Nephrology Meeting Geoffrey A. Block 1, Pablo E. Pergola 2, Lesley

More information

Bioresorbable polymer drug-eluting stents in PCI

Bioresorbable polymer drug-eluting stents in PCI EARN 3 FREE CPD POINTS CARDIOVASCULAR Leader in digital CPD for Southern African healthcare professionals The BIOFLOW-V trial, using the Orsiro ultrathin strut stent with biodegradable polymer, showed

More information

Extracorporeal Cardiopulmonary Resuscitation (ECPR) for Cardiac Arrest

Extracorporeal Cardiopulmonary Resuscitation (ECPR) for Cardiac Arrest Extracorporeal Cardiopulmonary Resuscitation (ECPR) for Cardiac Arrest A review of the evidence Dr. Steven Brooks Associate Professor Queen s University, Department of Emergency Medicine Faculty/Presenter

More information

SpringerLink Header: Hypertension (WB White and AJ Peixoto, Section

SpringerLink Header: Hypertension (WB White and AJ Peixoto, Section SpringerLink Header: Hypertension (WB White and AJ Peixoto, Section Editors) What Are Optimal Blood Pressure Targets for Patients with Hypertension and Chronic Kidney Disease? Gopesh K. Modi, MD DM 1,

More information

Lessons learned From The National PCI Registry

Lessons learned From The National PCI Registry Lessons learned From The National PCI Registry w a v e On Behalf of The Publication Committee of the National PCI Registry Objectives & Anticipated Achievements To determine the epidemiology of patients

More information

Management of New-Onset Proteinuria in the Ambulatory Care Setting. Akinlolu Ojo, MD, PhD, MBA

Management of New-Onset Proteinuria in the Ambulatory Care Setting. Akinlolu Ojo, MD, PhD, MBA Management of New-Onset Proteinuria in the Ambulatory Care Setting Akinlolu Ojo, MD, PhD, MBA Urine dipstick results Negative Trace between 15 and 30 mg/dl 1+ between 30 and 100 mg/dl 2+ between 100 and

More information