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Unenhanced renal magnetic resonance angiography in patients with chronic kidney disease & suspected renovascular hypertension: Can it affect patient management?

BACKGROUND & OBJECTIVES: Renal artery stenosis (RAS) is an important cause of severe hypertension in patients with chronic kidney disease (CKD). It is important to detect RAS early as it can reverse hypertension and stop rapid deterioration of renal function. The potential drawbacks of various i...

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Autores principales: Yamuna, J., Chandrasekharan, Anupama, Rangasami, Rajeswaran, Ramalakshmi, S., Joseph, Santhosh
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Medknow Publications & Media Pvt Ltd 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5890592/
https://www.ncbi.nlm.nih.gov/pubmed/29578191
http://dx.doi.org/10.4103/ijmr.IJMR_1613_15
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author Yamuna, J.
Chandrasekharan, Anupama
Rangasami, Rajeswaran
Ramalakshmi, S.
Joseph, Santhosh
author_facet Yamuna, J.
Chandrasekharan, Anupama
Rangasami, Rajeswaran
Ramalakshmi, S.
Joseph, Santhosh
author_sort Yamuna, J.
collection PubMed
description BACKGROUND & OBJECTIVES: Renal artery stenosis (RAS) is an important cause of severe hypertension in patients with chronic kidney disease (CKD). It is important to detect RAS early as it can reverse hypertension and stop rapid deterioration of renal function. The potential drawbacks of various imaging modalities used to detect RAS including contrast-related adverse effects associated with diagnostic angiography have led to increasing interest in unenhanced magnetic resonance (MR) renal angiography. The aim of this study was to detect and grade RAS in patients with CKD and suspected renovascular hypertension using unenhanced MR angiography (UMRA) and to identify patients with significant RAS (>70%) who would subsequently require further investigation and revascularization. METHODS: Thirty five CKD patients with suspected RAS were subjected to UMRA using non-contrast MR angiography of ArTery and VEins 3D True fast imaging with steady state precession technique over a three year period. Patients with RAS >70 per cent on UMRA were subjected to digital subtraction angiography (DSA) with intervention if indicated. RESULTS: In all, 76 renal arteries were evaluated using UMRA in 35 patients, of which 18 arteries showed stenosis and 11 were haemodynamically significant (eight patients). Seven patients (10 renal arteries) underwent DSA. INTERPRETATION & CONCLUSIONS: An association between UMRA and DSA findings was obtained in six patients (nine renal arteries), and these patients were stented. Post-procedure follow up showed good improvement in blood pressure and renal function. UMRA was found to be a useful non-invasive imaging modality to detect RAS in CKD patients. It can identify patients who require further invasive angiography and revascularization.
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spelling pubmed-58905922018-04-19 Unenhanced renal magnetic resonance angiography in patients with chronic kidney disease & suspected renovascular hypertension: Can it affect patient management? Yamuna, J. Chandrasekharan, Anupama Rangasami, Rajeswaran Ramalakshmi, S. Joseph, Santhosh Indian J Med Res Original Article BACKGROUND & OBJECTIVES: Renal artery stenosis (RAS) is an important cause of severe hypertension in patients with chronic kidney disease (CKD). It is important to detect RAS early as it can reverse hypertension and stop rapid deterioration of renal function. The potential drawbacks of various imaging modalities used to detect RAS including contrast-related adverse effects associated with diagnostic angiography have led to increasing interest in unenhanced magnetic resonance (MR) renal angiography. The aim of this study was to detect and grade RAS in patients with CKD and suspected renovascular hypertension using unenhanced MR angiography (UMRA) and to identify patients with significant RAS (>70%) who would subsequently require further investigation and revascularization. METHODS: Thirty five CKD patients with suspected RAS were subjected to UMRA using non-contrast MR angiography of ArTery and VEins 3D True fast imaging with steady state precession technique over a three year period. Patients with RAS >70 per cent on UMRA were subjected to digital subtraction angiography (DSA) with intervention if indicated. RESULTS: In all, 76 renal arteries were evaluated using UMRA in 35 patients, of which 18 arteries showed stenosis and 11 were haemodynamically significant (eight patients). Seven patients (10 renal arteries) underwent DSA. INTERPRETATION & CONCLUSIONS: An association between UMRA and DSA findings was obtained in six patients (nine renal arteries), and these patients were stented. Post-procedure follow up showed good improvement in blood pressure and renal function. UMRA was found to be a useful non-invasive imaging modality to detect RAS in CKD patients. It can identify patients who require further invasive angiography and revascularization. Medknow Publications & Media Pvt Ltd 2017-11 /pmc/articles/PMC5890592/ /pubmed/29578191 http://dx.doi.org/10.4103/ijmr.IJMR_1613_15 Text en Copyright: © 2017 Indian Journal of Medical Research http://creativecommons.org/licenses/by-nc-sa/4.0 This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.
spellingShingle Original Article
Yamuna, J.
Chandrasekharan, Anupama
Rangasami, Rajeswaran
Ramalakshmi, S.
Joseph, Santhosh
Unenhanced renal magnetic resonance angiography in patients with chronic kidney disease & suspected renovascular hypertension: Can it affect patient management?
title Unenhanced renal magnetic resonance angiography in patients with chronic kidney disease & suspected renovascular hypertension: Can it affect patient management?
title_full Unenhanced renal magnetic resonance angiography in patients with chronic kidney disease & suspected renovascular hypertension: Can it affect patient management?
title_fullStr Unenhanced renal magnetic resonance angiography in patients with chronic kidney disease & suspected renovascular hypertension: Can it affect patient management?
title_full_unstemmed Unenhanced renal magnetic resonance angiography in patients with chronic kidney disease & suspected renovascular hypertension: Can it affect patient management?
title_short Unenhanced renal magnetic resonance angiography in patients with chronic kidney disease & suspected renovascular hypertension: Can it affect patient management?
title_sort unenhanced renal magnetic resonance angiography in patients with chronic kidney disease & suspected renovascular hypertension: can it affect patient management?
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5890592/
https://www.ncbi.nlm.nih.gov/pubmed/29578191
http://dx.doi.org/10.4103/ijmr.IJMR_1613_15
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