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Your search term(s) "renal artery stenosis " returned 10 results.
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Comparative Effectiveness of Management Strategies for Renal Artery Stenosis: 2007 Update. Rockville, MD: Agency for Healthcare Research and Quality. 2007. 33 p.
This report is an update to a Comparative Effectiveness Review about management strategies for renal artery stenosis (RAS). The original review in October 2006 included all studies of patients with atherosclerotic RAS (ARAS) that compared two or more interventions. In addition, it reviewed recent prospective cohort––single arm––studies of angioplasty with stent placement, prospective cohort studies of medical interventions, cohort studies of RAS natural history, and prospective or large retrospective studies of surgical bypass. This update evaluated the same questions and used the same eligibility criteria, updating the literature search through April 2007. This report does not address the management of fibromuscular dysplasia, renal transplant recipients, or patients who have a previous failed revascularization. The report includes an executive summary, introduction, discussion of methods, report of results, discussion of findings, a list of references, a list of abbreviations, a table that summarizes the reviewed studies, and appendices of the search strategy, excluded studies, peer reviewers, and supplemental tables and figures. The authors contend that none of the studies evaluated the principal question of interest, that is, the relative effects of intensive medical therapy and angioplasty with stent for patients with ARAS. They conclude that the evidence does not support one treatment approach over the other for the general population of people with ARAS. 5 figures. 1 table. 93 references.
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Comparative Effectiveness of Management Strategies for Renal Artery Stenosis: 2007 Update. Executive Summary. Rockville, MD: Agency for Healthcare Research and Quality (AHRQ). 2007. 4 p.
This report is a 2007 update to a 2006 Comparative Effectiveness Review on management strategies for renal artery stenosis (RAS). The original systematic review included all studies of patients with atherosclerotic RAS (ARAS) that compared two or more interventions, and single arm studies of angioplasty with stent placement, prospective cohort studies of medical interventions, cohort studies of RAS natural history, and prospective or large retrospective studies of surgical bypass. The 2007 update evaluated the same questions and used the same eligibility criteria. The questions focused on the evidence for or against aggressive medical therapy compared with renal artery angioplasty with stent placement on long-term clinical outcomes; what clinical, imaging, laboratory, and anatomic characteristics are associated with improved or worse outcomes; and what treatment variables are associated with improved or worse outcomes, including periprocedural medications, type of stent, use of distal protection devices, or other adjunct techniques. The update added eight new studies to the 60 studies included in the original report. The authors conclude that the evidence does not support one treatment approach over the other for the general population of people with ARAS. Readers are referred to the full report online at www.effectivehealthcare.ahrq.gov/reports/final.cfm.
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Management of Atherosclerotic Renal Artery Stenosis: Clinician’s Guide. Rockville, MD: Agency for Healthcare Research and Quality. 2007. 2 p.
This fact sheet summarizes clinical evidence about the effectiveness and safety of angioplasty and medical therapy for treating atherosclerotic renal artery stenosis (ARAS). The fact sheet does not address how to choose a diagnostic strategy for assessing suspected ARAS and does not discuss renal artery stenosis due to fibromuscular dysplasia. The fact sheet stresses that, overall, insufficient evidence exists to determine whether angioplasty with stenting is a better treatment for ARAS than aggressive medical therapy alone. Both medical therapy and angioplasty lower blood pressure. Attainment of blood pressure control is more likely after angioplasty than with medical therapy alone. However, the benefits of angioplasty may be limited to people with bilateral disease. A small percentage––4 to 18 percent––of people who have had angioplasty plus stent can discontinue blood pressure medications. The risks of drug therapy for ARAS include side effects of antihypertensive drugs, such as dizziness, sexual problems, headache, and cough. The risks of angioplasty include death after surgery in about 1 percent of patients and restenosis without 40 months in about 10 to 21 percent of patients. Readers are referred to a website for additional information: www.effectivehealthcare.ahrq.gov. 1 figure.
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ACE Inhibition Renography in the Evaluation of Suspected Renovascular Hypertension. IN: Piepsz, A.; Prigent, A., eds. Functional Imaging in Nephro-Urology. New York, NY: Informa Healthcare USA. 2006. pp 149-162.
This chapter about the use of angiotensin-converting enzyme (ACE) inhibition renography in the evaluation of suspected renovascular hypertension is from a textbook that presents a comprehensive look at the use of functional imaging in nephrourology. The text focuses on management strategies based on the patient, the choice of modality, and cost implications for various imaging modalities commonly used in nephrourology. This chapter discusses the need for diagnostic procedures that can accurately select those hypertensive patients with renal artery stenosis (RAS) most likely to be cured or improved after revascularization. The author maintains that ACE inhibition renography in an appropriately screened hypertensive patient with preserved renal function can detect renovascular disease with a sensitivity and specificity in excess of 90 percent. However, it is not a test for the detection of RAS. ACE inhibition renography is a sensitive, specific, and cost-effective test for renovascular hypertension in patients with normal or near-normal renal function. The author discusses areas of controversy and suggests directions for future research, including aspirin renography and automated processing. 8 figures. 61 references.
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Radiological Modalities in Renovascular Disease. IN: Prigent, A.; Piepsz, A., eds. Functional Imaging in Nephro-Urology. New York, NY: Informa Healthcare USA. 2006. pp 132-148.
This chapter about the use of radiological modalities in renovascular disease is from a textbook that presents a comprehensive look at the use of functional imaging in nephrourology. The text focuses on management strategies based on the patient, the choice of modality, and cost implications for various imaging modalities commonly used in nephrourology. This chapter reviews the four objectives for radiological imaging techniques that are currently available to detect and characterize renal artery stenosis (RAS) in terms of anatomical and hemodynamical severity, to assess the anatomical consequences of the RAS on the artery itself and on the renal parenchyma, to assess the functional and cellular consequences of the RAS on the kidney, and to identify criteria of associated renal impairment related to renovascular disease (RVD). The author notes that the relationships among RAS, hypertension, and renal function vary from patient to patient and are difficult to assess, but their severity and their association increase the patient’s risks. Detection of an RAS requires further evaluation of the severity of narrowing and its consequences on renal flow, renal artery, renal parenchyma, and renal function to improve the interobserver variability and to define predictive factors of improvement after revascularization. The techniques discussed include Doppler ultrasound (US), helical computerized tomographic angiography (CTA), magnetic resonance angiography (MRA) and intra-arterial digital subtraction angiography (IADSA). Intravenous (IV) urography and IV digital subtraction angiography (IVDSA) are no longer recommended. The author concludes that in experienced hands, US remains the most useful tool for first line study. Full-color and black-and-white reproductions of many of the testing modalities are included. 12 figures. 5 tables. 100 references.
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Renovascular Hypertension. IN: Nilsson, K.R.; Piccini, J.P., eds. Osler Medical Handbook. Philadelphia, PA: Saunders. 2006. pp. 741-747.
Renovascular hypertension is a secondary cause of hypertension that results from poor renal perfusion secondary to flow-limiting lesions. This chapter on renovascular hypertension is from a handbook that provides the essentials of diagnosis and treatment, as well as the latest in evidence-based medicine, for residents working bedside, in-patient care. The chapter begins with a presentation of essential Fast Facts and concludes with Pearls and Pitfalls useful to the practicing internist. The body of the chapter is divided into sections: Epidemiology, Clinical Presentation, Diagnosis, and Management. Specific topics covered in this chapter include the two most common causes of renovascular hypertension: atherosclerosis (which causes about 90 percent) and fibromuscular dysplasia (FMD); stenosis (narrowing) greater than 75 percent in one or both renal arteries used as the diagnosis of renal artery stenosis; and the retrospective diagnosis of renovascular hypertension when blood pressure control improves after revascularization of a stenotic lesion. The chapter concludes with a list of references, each labeled with a 'strength of evidence' grade to help readers determine the type of research available in that reference source. 2 figures. 17 references.
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Diagnostic Imaging in Kidney Transplantation. IN: Danovitch, G.M. Handbook of Kidney Transplantation. Philadelphia, PA: Lippincott Williams and Wilkins. 2005. pp. 347-368.
The clinician evaluating a patient with renal transplant dysfunction has the choice of a variety of imaging procedures, including ultrasound (US), nuclear medicine (NM) or molecular imaging, computed tomography (CT), magnetic resonance imaging (MRI), and excretory urography. This chapter on diagnostic imaging in kidney transplantation is from a handbook that offers a practical guide for health care providers who manage kidney transplant patients. In this chapter, the authors focus on the use of US and NM techniques in kidney transplantation. They also note that CT, MRI, and urography may, on occasion, be the optimal imaging modalities for certain clinical problems encountered in renal transplant recipients. Specific topics include the radiologic evaluation of the living donor; radiologic techniques in the early posttransplant period (up to 3 months), including that for hematomas, urinomas, lymphoceles, abscesses, and acute rejection; nuclear medicine imaging of graft function and dysfunction; posttransplantation vascular complications, including arterial thrombosis, infarction, renal vein thrombosis, chronic rejection, renal artery stenosis, arteriovenous fistulas, and pseudoaneurysms; and measurement of glomerular filtration rate. 13 figures. 1 table. 13 references.
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Evaluation and Treatment of Graft Dysfunction. In: Medical Management of Kidney Transplantation. Philadelphia, PA: Lippincott Williams and Wilkins. 2005. pp. 153-187.
Accurate and timely diagnosis of the cause and then effective treatment of allograft dysfunction in order to minimize any irreversible injury is a critical factor in maximizing long-term allograft success rates. This chapter on the evaluation and treatment of graft dysfunction is from a textbook that provides a compendium of the latest advances and understandings regarding the complex medical problems seen in kidney transplant patients. The first section of the chapter considers the measurement of allograft function, including the roles of serum creatinine, 24 hour creatinine clearance, formulas that estimate glomerular filtration rate (GFR), serum cystatin C, radionuclide and radiocontrast determinations of GFR, ultrasonography, radionuclide imaging, and noninvasive diagnosis of acute rejection. The authors also consider dysfunction immediately after transplantation, including evaluation, hyperacute rejection, vascular occlusion, delayed graft function, urologic complications, and hypovolemia; deterioration of allograft function early after transplantation, including diagnosis, acute cellular rejection, acute antibody-mediated rejection, urologic complications, acute calcineurin inhibitor nephrotoxicity, and de novo thrombotic microangiopathy; and deterioration of allograft function more than 6 months after transplantation, including chronic allograft nephropathy, chronic calcineurin inhibitor nephrotoxicity, chronic allograft rejection, late acute rejection, chronic humoral rejection, transplant renal artery stenosis, and recurrent and de novo glomerular disease. 9 tables. 439 references.
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Transplant Operation and Its Surgical Complications. IN: Danovitch, G.M. Handbook of Kidney Transplantation. Philadelphia, PA: Lippincott Williams and Wilkins. 2005. pp. 193-211.
Kidney transplantation is an elective or semi-elective surgical procedure performed in patients who have undergone careful preoperative assessment and preparation. Chronic dialysis enables patients to be maintained in optimal condition and provides time to address potentially complicating medical and surgical issues. The authors of this chapter discuss these preparations. The chapter, on the transplant operation and its surgical complications, is from a handbook that offers a practical guide for health care providers who manage kidney transplant patients. Specific topics include immediate preoperative preparations, operative techniques, surgical considerations in young children, intraoperative fluid management, dual-kidney transplantation, and the surgical complications of kidney transplantation, including wound infection, lymphocele, bleeding, graft thrombosis, the need for perioperative anticoagulation, renal artery stenosis, urine leaks, and ureteral obstruction. An additional section discusses allograft nephrectomy (removal of prior kidney transplants that have failed). 6 figures. 2 tables. 14 references.
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Pitfalls in Imaging for Renal Stenosis. Annals of Internal Medicine. 141(9): 730-731. November 2004.
Renal artery stenosis (constriction) can progress to threaten kidney function and complicate congestive heart failure; it is an important cause of secondary hypertension. This editorial addresses some of the pitfalls in imaging studies used to measure renal artery stenosis. The editorial accompanies an article in this same issue on noninvasive tests for diagnosing renal artery stenosis (Vasbinder et al) that demonstrated problems with limited performance of vascular imaging methods. The editorial stresses that before starting out on the path to rule out renal artery stenosis, the internist must decide whether the risks for treatment-resistant hypertension, underlying ischemic nephropathy (kidney disease caused by lack of blood flow), or both outweigh the risks associated with invasive tests and treatment. However, benefits from renal revascularization surgery can be substantial, so the need to evaluate the vascular supply to the kidneys must be balanced against the risks for invasive studies for each patient.
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