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Abstract: TH-PO132

Benefits of Renal Artery Stenting in Select Cases with Severe Renal Artery Stenosis and AKI

Session Information

Category: Trainee Case Report

  • 102 AKI: Clinical, Outcomes, and Trials


  • 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

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.


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.

 AgeSexPMHTobacco useAntiHTN medsBP on admissionAdmission SCrPeak SCrRenal sizes on USRenal artery DopplerDischarge SCr
Case 178FHTN
Current smokerAmlodipine
160/70 mmHg2.7 mg/dL4.07 mg/dLRK 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
Case 272FHTN, DM, CKD 4, CAD, HLDFormer smokerAmlodipine
156/58 mmHg3.35 mg/dL5.26 mg/dLRK 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