肾动脉狭窄支架术现状.pptxVIP

肾动脉狭窄支架术现状 ARAS 90%FMD 10% mon causes of renal artery stenosisHTRenal dysfunctionAngina pectorisParoxysmal acute pulmonary edemaPresentation of renal artery stenosis Haemodynamics:　50%　Renal perfusion pressure reduction　70%　RPP75-85mmHg, autonomic regulation lose　Pathology:Glomcrulus:arteriosclerosis, mesenterium proliferation,Nephric tubule:epithelial cells denudation、apoptosis,Focal necrosis,Renal interstitium:Inflammatory cell infiltration、fibrocyte proliferationEnd stage :renal atrophyAtherosclerotic nephrosis Natural course of ARASstudyNF/U(mon)prograssion(%)Occlusion(%)Capierleollefson4854539SchreibeDevelop to total occlusion within 5 years 15%Deterioration gradually within 5 years 10-20%Develop to ESRD annually 5-15%3-year mortality in Pt、 with ESRD on dislysis 50%Survival of ARAS Pt、 with ESRD on dislysis: 5-year 18% 10-year 5%Atherosclerotic RAS progression Conlon et al, Kidney Int 2001 Oct;60:490-7Renal angio in 3987 Pt、 undergoing cath Independent predictor of mortality Conlon et al, Kidney Int 2001 Oct;60:490-7Renal angio in 3987 Pt、 undergoing cathIndependent predictor of mortality Case 1: male,62y,HT Case 2: male, 78y,HT, DM, Renal dysfunction Renal function:improement: GFR increse 15% /Scr decrease 0、2mg/dLstable: GFR change15% / Scr change 0、2mg/dLineffective: GFR decrease 15% / Scr increase 0、2mg/dL benefit: Improement or stableBlood pressure:cure: SBP140mmHg and DBP90mmHg, without any anti-hypertension drugs,improement: SBP140mmHg and DBP90mmHg, or, DBPdecrease 15mmHg with similar or less anti-hypertension drugsineffective: BP change not meet the above standardbenefit: cure and improvementStandard for prog