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Current approaches to atherosclerotic obstructive renal artery stenosis

机译：动脉粥样硬化性阻塞性肾动脉狭窄的当前方法

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Increased lifespan in the last few decades has substantially changed the scenario for renal artery stenosis. Indeed, because older populations show a higher prevalence of atherosclerotic disease, the incidence of atheromatous renal artery stenosis has also increased. Intuitively, one could surmise that stenosis removal should void both the hypertension and the kidney damage resulting from the obstructive stenosis. Surprisingly, a number of important clinical trials have failed to show the reversion seen in experimental models. The reasons for these differences may be linked to chronicity and inflammation associated with the atherosclerotic lesion. However, the failure to obtain a favorable response may also be related to abnormalities in the contralateral kidney. Indeed, this apparently normal kidney should work to compensate the hemodynamic effects of the ipsilateral stenosed kidney. Instead, structure and function in the contralateral kidney can be altered in renal artery stenosis to the point that this nonstenotic kidney may sustain both, hypertension and progressive kidney disease. Certainly, comparing the effects of clip removal in the Goldblatt model to angioplasty in clinical settings with atherosclerotic lesions may be totally inappropriate. Nevertheless, there remain certain clinical situations such as bilateral renal arterial disease, congestive heart failure, and progressive renal failure, where angioplasty may be an alternative. These approaches however are yet to be tested.
机译：在过去的几十年中，寿命的延长已大大改变了肾动脉狭窄的情况。确实，由于老年人群患动脉粥样硬化疾病的患病率更高，因此动脉粥样硬化性肾动脉狭窄的发生率也增加了。凭直觉，人们可以推测，去除狭窄应使高血压和阻塞性狭窄导致的肾脏损害无效。令人惊讶的是，许多重要的临床试验未能显示出在实验模型中看到的逆转。这些差异的原因可能与动脉粥样硬化病变相关的慢性和炎症有关。但是，未能获得满意的反应也可能与对侧肾脏的异常有关。确实，这个显然正常的肾脏应​​该起到补偿同侧狭窄肾脏的血液动力学作用的作用。相反，在肾动脉狭窄中，对侧肾脏的结构和功能可能会发生改变，以至于这种非狭窄的肾脏可能同时患有高血压和进行性肾脏疾病。当然，将Goldblatt模型中的夹子去除效果与动脉粥样硬化病变的临床血管成形术进行比较可能是完全不合适的。然而，仍然存在某些临床情况，例如双侧肾动脉疾病，充血性心力衰竭和进行性肾衰竭，其中血管成形术可以替代。但是，这些方法尚待测试。

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