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| Dr Jörg Radermacher is a European hypertension specialist and is Professor of Medicine in nephrology at Hannover Medical School and Head of the
Department of Nephrology at Minden. His current research is focused on clinical care for patients with hypertension and chronic kidney disease. He has published studies related to the value of colour Doppler
sonography in the diagnosis and prognosis of renal artery stenosis and other renal diseases, two of which have been published in the New England Journal of Medicine. |
Renovascular hypertension 1: Epidemiology and clinical presentation
Jörg Radermacher
Zentrum für Innere Medizin Nephrologie,
Klinikum Minden, Germany
Address for correspondence:
PD. Dr. med. Jörg Radermacher
Department of Nephrology
Klinikum Minden
Friedrichstrasse 17
32427 Minden, Germany
Tel: +49 (0)571 801 3021 Fax: +49 (0)571 801 3076
Email: joerg.radermacher@klinikum-minden.de
Abstract
Renovascular disease is present in about 10–40% of patients with end-stage renal disease, and constitutes the fastest-growing group of end-stage renal disease patients. The unselective correction of renal artery stenosis has led to disappointing results. Most studies that have compared conservative treatment with
angioplasty have found only modest or no beneficial effects of angioplasty on blood pressure and renal
function. It is therefore mandatory to evaluate the
functional significance of a stenosis before intervention. Patients most likely to respond favourably to
revascularisation should be identified. Factors that affect outcome include the severity of renal artery stenosis and, most importantly, underlying renal disease. This underlying disease can prevent a favourable response despite successful correction of renal artery stenosis. The best methods to classify patients as responders or non-responders to intervention are Doppler ultrasonography – which evaluates the renal resistance index - the percentage reduction of the end-diastolic flow as compared with the systolic flow, calculated as [(1- (end diastolic velocity/maximum systolic velocity)) x 100] – or captopril scintigraphy. In patients with a renal resistance index ≥80%, improvement of renal function or blood pressure is highly unlikely, despite successful correction of renal artery stenosis. Identifying patients at risk for irreversible loss of renal function,
and who may benefit from intervention, is a high research priority.
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