1、Unilateral atherosclerotic renal artery stenosis: the change of total and separate kidney function following stenting1Patient: A 70-year-old man with a 15-year history of hypertension, left renal artery stenosis (RAS) due to atherosclerosis and stenosis judged to be above 70% by doppler ultrasonogra

2、phy . RI=0.65 Systolic BP： 175mmHg； dastolic BP： 98 mmHg. biochemical tests indicated: creatinine : 2.55 mg/dl Cr. Clearance: 45.3ml/min2Question:l Whether he can undergo stentiong？ YESl Can stenting of RAS due to atherosclerosis be followed by stabilization or improvement of Ccr at the stented kidn

3、ey? YES lHow will this effect the renal funcion of the contralateral renal ? UNKNOWN 3Retrieve:lKey words : atherosclerotic renal artery stenosis stenting kidney functionlRetrieval limits : Clinical Trial Meta-Analysis Randomized Controlled TriallDatabase: Clinical evidence; Cochrane Library; Pubmed

4、; and so on 4Search outcome:Pubmed:lBMC Nephrology 2004, 5:15 doi:10.1186/1471-2369-5-15l Atherosclerotic renal artery stenosis: one year outcome of total and separate kidney function following stentingBMA:英國醫(yī)學(xué)師協(xié)會5Evaluation:l validity(真實實性)l importance(重要性)l application(適用性)6 Validity:lWas the assi

5、gnment of patients to treatment randomized? RCTlWere the groups similar at the start of the trial? Clinical and biochemical data of the treated and control groups are reported in Table 1. There was no significant difference between experimental and control groups78 Validity: Methods The group of 27

6、patients, 67.33 6.8 years of age, creatinine of 2.15 0.9 mg/dl, following stenting, were followed at intervals with biochemical tests, renal scintigraphy and doppler ultrasonography. The control group of 19 patients (70.0 6.1 years, creatinine 1.99 0.7 mg/dl) was also followed for one year. All pati

7、ents had a unilateral stenosis judged by ultrasonography to be above 70%.9 Validity:lWas follow-up of patients sufficiently long and complete? During 12 months observation period one patient of the stented group began dialysis treatment, while in the control group 4 patients died of cardiovascular e

8、vents and one patient started the dialysis treatment.lWere all patients analyzed in the groups to which they were? efficacy analysis10Validity:lWere patients, clinicians, and study personnel kept blind to treatment? a double-blind controlled triallWere groups treated equally, apart from the experime

9、ntal therapy? No other therapies.11Evaluation:l validityl importancel application12ImportancelHow precise is this estimate of the treatment effect？ 95%CIlWhat is the magnitude of the treatment effect?13A significant drop in systolic and diastolic blood pressure at all control times compared to basal

10、 values, was found in the stented patients.While no significant blood pressure drop was found in the patients not undergoing the PTA stenting procedure 14 An increase in creatinine clearance and a slight fall in serum creatinine, however not reaching a significance level, was observed in the stented

11、 group.While no increment in creatinine clearance was found in the control group.15An increment in the percentage of total glomerular filtration in the stented kidney as a group was found.While a significant fall in percentage of filtration was found on the controlateral side.The overall renal funct

12、ion was stable.16Evaluation:l validityl importantl application17lIs our patient so different from those in the study that its result cannot apply? 70 years of age left renal artery stenosis (RAS) due to atherosclerosis stenosis judged to be above 70% RI=0.65lIs the treatment feasible in our setting?

13、 Implementation technique level Monitoring and management level Economic burden Patients will Application18ApplicationlWhat are our patients values and expectations for both the outcome we are trying to prevent and the treatment we are offering? Stenting of RAS due to atherosclerosis is followed by

14、stabilization or improvement of Ccr, mainly at the stented kidney, while contralateral renal function showed a decrease. The reduction in contralateral kidney function has been attributed to ultrafiltration in the non stenotic kidney, declining after stenting of the stenotic contralateral renal arte

15、ry. In addition, hemodynamic factors consequent to a decrease in renin-angiotensin activity could be considered as a factor.19Resistance index appeared to be a risk factor of the functional outcome.2021ApplicationTherefore, also in case of overall stabilization of renal function following the stenting procedure, improvement of the stented side and reduction of hyperfiltration on the contralateral side are both favorable evolutions for long-