Abstract: TH-PO132
Benefits of Renal Artery Stenting in Select Cases with Severe Renal Artery Stenosis and AKI
Session Information
- Drug Events Trainee Case Reports
November 07, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Trainee Case Report
- 102 AKI: Clinical, Outcomes, and Trials
Authors
- Bobba, Aniesh, Washington University in St. Louis, St. Louis, Missouri, United States
- Chuu, Andy, Washington University in St. Louis, St. Louis, Missouri, United States
- Cheng, Steven C., Washington University School of Medicine, St. Louis, Missouri, United States
- Vijayan, Anitha, Washington University in St. Louis, St. Louis, Missouri, United States
Introduction
Prevalence of RAS in US is estimated to be 7% in those >65 years.Two large RCTs demonstrated that RA stenting do not improve CV and renal outcomes.We present 2 cases of oliguric AKI 2o to RAS who had prompt improvement in renal function after RA stenting.
Case Description
Case 1: A 78-year-old WF with hx of uncontrolled HTN and baseline SCr 1.3-1.5 mg/dL presented with SOB, edema, and AKI. Admission SCr was 2.7 mg/dL and she developed oliguric AKI.Renal US with Doppler was consistent with bilateral RAS (Table1). Right RA stenting was performed, with immediate improvement in UO and SCr (Fig1&2A/B). At 6-mo f/u, her SCr is 3.3 mg/dL with BP of 114/62 mmHg on 3 meds, incl ACEI.
Case 2: A 72-year-old WF with hx of uncontrolled HTN, CKD (baseline SCr 1.8-2.5 mg/dL) and recurrent hospitalizations for vol overload, presented with SOB and oliguric AKI.Renal US with Doppler revealed L RAS (Table 1). She developed oliguric AKI and left RA stenting was performed (Fig 1), with prompt improvement in renal function. At 5-mo f/u, her BP is 138/64 mmHg on 3 meds, including an ARB, and her SCr was 1.62mg/dL. She has not had any further hospitalizations for vol overload.
Discussion
After publication of 2 large RCTs (ASTRAL & CORAL), RA stenting has fallen out of favor in tx of RAS. However, it is important to note that these studies excluded patients with severe disease, pulm edema and renal failure. Thus, determination for risks and potential benefits of RA stenting needs to be individualized high-risk pts. RA stenting in our 2 pts with high CV risk averted imminent dialysis, improved BP and allowed use of RAAS blockade.
| Age | Sex | PMH | Tobacco use | AntiHTN meds | BP on admission | Admission SCr | Peak SCr | Renal sizes on US | Renal artery Doppler | Discharge SCr | |
| Case 1 | 78 | F | HTN CKD 3 HLD | Current smoker | Amlodipine Triamterene HCTZ | 160/70 mmHg | 2.7 mg/dL | 4.07 mg/dL | RK 9.4 cm LK 8.6 cm | PSV R RA origin: 404 cm/sec PSV L RA origin: 271 cm/sec PSV aorta: 110 cm/sec | 2.15 |
| Case 2 | 72 | F | HTN, DM, CKD 4, CAD, HLD | Former smoker | Amlodipine Carvedilol Clonidine Furosemide | 156/58 mmHg | 3.35 mg/dL | 5.26 mg/dL | RK 6.6cm LK 10.0 cm | PSV R RA origin: 121 cm/sec PSV L RA origin: >400 cm/sec PSV aorta 138 cm/sec | 1.8 mg/dL |