关键词: 肾动脉梗阻, 支架, 肾小球率过滤, 肾血流量, 有效, 肾滤过分数

Abstract:

Objective： To investigate the significance of filtration fraction (FF) and renal artery sten-ting in the treatment of atherosclerotic renal artery stenosis. Methods: In the study, 42 cases of renal artery stenosis were treated with 52 renal artery stent implantation. Percutaneous transluminal renal angioplasty and stent (PTRAS) of the patients’ health side kidney, ipsilateral kidney (renal) glomerular filtration rate (GFR), renal effective renal plasma flow effective renal plasma flow (ERPF), kidney filtration fraction changes of preoperative and postoperative serum creatinine (SCR) and the changes in the patients with blood pressure (SBP) and the changes after taking antihypertensive drugs were observed and analyzed. Results:The 52 cases of renal artery stent implantation were all successful. Preoperative ipsilateral GFR was significantly lower than that of normal side (t=－3.989, P=0.000); preoperative ipsilateral ERPF was significantly lower than the contralateral side (t=－4.926, P=0.000). On both sides, the overall FF values were equal (t=1.273, P=0.207). Postoperative ipsilateral renal GFR was increased, but there was no statistical difference (t=－1.411, P=0.164). Postoperative ipsilateral renal ERPF was increased significantly (t=－4.954, P=0.000), and FF lower ( closer to the normal value (t=3.274, P=0.002). Postoperative side GFR was significantly reduced (t=2.569, P=0.000), the contralateral ERPF was significantly reduced (t=3.889, P=0.001), and FF had no significant change (t=－0.758, P=0.454). Postoperative side GFR was lower than that of the contrala-teral (t=－3.283, P=0.002) and postoperative side ERPF was still lower than that of the contralateral (t=－3.351, P=0.001), but on both sides, the FF values were equal (t=－0.361, P=0.719). Preoperative FF was relatively normal in the patients with kidney, and the postoperative FF value change was small (t=0.799, P=0.430); preoperative FF was significantly higher in the patients with kidney, and the postoperative FF value was lower than the preoperative (normal value, t=5.299, P=0.000). Postoperative overall serum creatinine was significantly decreased (t=2.505, P=0.016); but for the patients with unilateral renal artery stenosis, the changes in serum creatinine had no statistical difference (t=1.228, P=0.299); and for the patients with bilateral renal artery stenosis and serum creatinine compared with the preoperative, the changes were decreased significantly (t=2.518, P=0.030); postoperative blood pressure (SBP) was significantly decreased compared with that before operation (t=8.945, P=0.000); antihypertensive drugs taken were decreased significantly compared with the preoperative (t=5.280, P=0.000). Conclusion: For the patients with renal artery stenosis, FF is a useful index to understand the pathophysiological process of renal ischemia. Whether preoperative FF is significantly increased or FF is relatively normal, should be regarded as the indications of renal artery stent implantation.

Key words: Renal artery obstruction, Stents, Glomerular filtration rate, Renal blood flow, effective, Filtration fraction