The Value Of Renal Vein Renin Measurement To Predict Blood Pressure Improvement After Percutaneous Revascularisation And Stenting For Renalartery Stenosis

ObjectiveThe purpose of this study is to evaluate the value of plasma renin activity (PRA) of renalvein to predict blood pressure (BP) response in patients with renal artery stenosis (RAS)after renal angioplasty and stenting.Patient and MethodsWe studied57hypertensive patients who were highly suspected of renovascularhypertension (RHV) between2002and2013in Department of Hypertension at ShanghaiRuijin Hospital. Before the angiography, the PRA of bilateral renal vein and theinfrarenal inferior vena cave were measured. The patients underwent renal arteryangiography to make a definitive diagnosis.24h ambulatory BP recordings wereobtained before intervention and follow-up. Patients were divided into Normal renalarteries, unilateral renal artery stenosis(Uni-RAS) and bilateral renal arterystenosis(Bi-RAS) groups. Compare the difference of split PRA between two sides. Renalvein renin measurements were used to calculate the ratios: Visch/Vctl (renal vein reninratio; RVRR);Vctl/Viivc;(Visch2Viivc)/Viivc;(Vctl2Viivc)/Viivc, where Visch andVctl indicate plasma renin activity (PRA) in the ischaemic and contralateral renal veins,respectively, and Viivc denotes PRA in the infrarenal inferior vena cava. Afterintervention(PTRA and stenting), according to blood pressure followed-up, the patients were divided into cured, improved and unchanged groups. We investigated the value ofthe indices mentioned above to predict blood pressure (BP) response in patients withrenal artery stenosis (RAS) after renal angioplasty and stenting.ResultsThere are altogether fifty-seven patients in this study. Three patients were excluded forrefusing renal artery angiography (RA).20with negative RA results was used as controlgroup. Thirty-four patients were diagnosed as having RAS,27were Uni-RAS and7wereBi-RAS. Pathogenesis with atherosclerotic renal artery stenosis (ARAS) wew29,fibromuscular dysplasia (FMD) were5.26patients underwent PTRA. Twenty-onepatients underwent stent placement, and five patients had angioplasty balloon catheterdilation. We studied the difference between PRA of two sides in Uni-RAS group(P>0.05). And none of the different indexes that can be derived from renal vein reninmeasurements clearly discriminated between the patients who did benefit fromintervention, and those who did not. In Uni-RAS group, even the most popular RVRR of1.5also cannot predict the blood pressure outcome after interventional treatment.ConclusionsIn conclusion, the value of renal vein renin measurements is meaningless for decidingwhether to revascularize a kidney with renal artery stenosis. There is an urgent need forpractical, effective and reliable measures.