Hypertensive load predicts recovery of renal function for patients undergoing revascularisation for renal artery stenosis
Abstract Renal ischaemia due to renal artery stenosis produces two differing responses - a juxtaglomerular hypertensive response and cortical renal dysfunction. The reversibility of renal impairment is not predictable, and thus renal revascularisation is controversial. This study aims to test the hy...
Saved in:
| Main Authors: | , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Nature Portfolio
2025-01-01
|
| Series: | Scientific Reports |
| Subjects: | |
| Online Access: | https://doi.org/10.1038/s41598-025-86663-y |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1832571707462778880 |
|---|---|
| author | Ben Edgar Rob Pearson Andrew Jackson Callum Stove Ram Kasthuri Keith Hussey Christian Delles Colin Geddes Patrick Mark Giles Roditi Linsay McCallum David B. Kingsmore |
| author_facet | Ben Edgar Rob Pearson Andrew Jackson Callum Stove Ram Kasthuri Keith Hussey Christian Delles Colin Geddes Patrick Mark Giles Roditi Linsay McCallum David B. Kingsmore |
| author_sort | Ben Edgar |
| collection | DOAJ |
| description | Abstract Renal ischaemia due to renal artery stenosis produces two differing responses - a juxtaglomerular hypertensive response and cortical renal dysfunction. The reversibility of renal impairment is not predictable, and thus renal revascularisation is controversial. This study aims to test the hypothesis that the hypertensive response to renal ischaemia reflects viable renal parenchyma, and thus could be used to predict the recovery in renal function. A retrospective analysis was performed of all patients who had renal revascularisation for renal impairment in a defined geographical area (West of Scotland, population 2.4 million) between 2008 and 2024. Clinical records were used to determine the pre-intervention blood pressure, anti-hypertensive medication load and renal function, and post-intervention outcomes. The Hypertensive Index (HTi), a combined measure of systolic blood pressure and antihypertensive drug load, was used as a measure of pre-intervention hypertensive response. 75 patients had intervention for renal impairment over 15 years (68 endovascular, 7 open). Mean pre-intervention serum creatinine of 323 µmol/L was reduced to 191 umol/L at discharge and 182 µmol/L at 6-month follow-up. Refractory hypertension (HTi > 120) was associated with a significant benefit from revascularisation with improved renal function (p = 0.003) and reduced risk of future dialysis (p = 0.001). Renal impairment with no hypertensive response was highly predictive of the need for future dialysis. The hypertensive index is a good predictor of the impact of renal revascularisation on improving renal function with good outcomes in selected patients, and the absence of this is an indicator of chronic non-reversible renal dysfunction. |
| format | Article |
| id | doaj-art-1fc53bfd94e5409bb41ed0c05df8d096 |
| institution | Kabale University |
| issn | 2045-2322 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | Nature Portfolio |
| record_format | Article |
| series | Scientific Reports |
| spelling | doaj-art-1fc53bfd94e5409bb41ed0c05df8d0962025-02-02T12:21:21ZengNature PortfolioScientific Reports2045-23222025-01-0115111210.1038/s41598-025-86663-yHypertensive load predicts recovery of renal function for patients undergoing revascularisation for renal artery stenosisBen Edgar0Rob Pearson1Andrew Jackson2Callum Stove3Ram Kasthuri4Keith Hussey5Christian Delles6Colin Geddes7Patrick Mark8Giles Roditi9Linsay McCallum10David B. Kingsmore11School of Cardiovascular and Metabolic Health, University of GlasgowGlasgow Renal and Transplant Unit, Queen Elizabeth University HospitalGlasgow Renal and Transplant Unit, Queen Elizabeth University HospitalDepartment of Interventional Radiology, Queen Elizabeth University HospitalDepartment of Interventional Radiology, Queen Elizabeth University HospitalDepartment of Vascular Surgery, Queen Elizabeth University HospitalSchool of Cardiovascular and Metabolic Health, University of GlasgowGlasgow Renal and Transplant Unit, Queen Elizabeth University HospitalSchool of Cardiovascular and Metabolic Health, University of GlasgowDepartment of Interventional Radiology, Queen Elizabeth University HospitalSchool of Cardiovascular and Metabolic Health, University of GlasgowSchool of Cardiovascular and Metabolic Health, University of GlasgowAbstract Renal ischaemia due to renal artery stenosis produces two differing responses - a juxtaglomerular hypertensive response and cortical renal dysfunction. The reversibility of renal impairment is not predictable, and thus renal revascularisation is controversial. This study aims to test the hypothesis that the hypertensive response to renal ischaemia reflects viable renal parenchyma, and thus could be used to predict the recovery in renal function. A retrospective analysis was performed of all patients who had renal revascularisation for renal impairment in a defined geographical area (West of Scotland, population 2.4 million) between 2008 and 2024. Clinical records were used to determine the pre-intervention blood pressure, anti-hypertensive medication load and renal function, and post-intervention outcomes. The Hypertensive Index (HTi), a combined measure of systolic blood pressure and antihypertensive drug load, was used as a measure of pre-intervention hypertensive response. 75 patients had intervention for renal impairment over 15 years (68 endovascular, 7 open). Mean pre-intervention serum creatinine of 323 µmol/L was reduced to 191 umol/L at discharge and 182 µmol/L at 6-month follow-up. Refractory hypertension (HTi > 120) was associated with a significant benefit from revascularisation with improved renal function (p = 0.003) and reduced risk of future dialysis (p = 0.001). Renal impairment with no hypertensive response was highly predictive of the need for future dialysis. The hypertensive index is a good predictor of the impact of renal revascularisation on improving renal function with good outcomes in selected patients, and the absence of this is an indicator of chronic non-reversible renal dysfunction.https://doi.org/10.1038/s41598-025-86663-yBlood pressureHypertensionIschaemiaRenal artery stenosisRenin-angiotensin system |
| spellingShingle | Ben Edgar Rob Pearson Andrew Jackson Callum Stove Ram Kasthuri Keith Hussey Christian Delles Colin Geddes Patrick Mark Giles Roditi Linsay McCallum David B. Kingsmore Hypertensive load predicts recovery of renal function for patients undergoing revascularisation for renal artery stenosis Scientific Reports Blood pressure Hypertension Ischaemia Renal artery stenosis Renin-angiotensin system |
| title | Hypertensive load predicts recovery of renal function for patients undergoing revascularisation for renal artery stenosis |
| title_full | Hypertensive load predicts recovery of renal function for patients undergoing revascularisation for renal artery stenosis |
| title_fullStr | Hypertensive load predicts recovery of renal function for patients undergoing revascularisation for renal artery stenosis |
| title_full_unstemmed | Hypertensive load predicts recovery of renal function for patients undergoing revascularisation for renal artery stenosis |
| title_short | Hypertensive load predicts recovery of renal function for patients undergoing revascularisation for renal artery stenosis |
| title_sort | hypertensive load predicts recovery of renal function for patients undergoing revascularisation for renal artery stenosis |
| topic | Blood pressure Hypertension Ischaemia Renal artery stenosis Renin-angiotensin system |
| url | https://doi.org/10.1038/s41598-025-86663-y |
| work_keys_str_mv | AT benedgar hypertensiveloadpredictsrecoveryofrenalfunctionforpatientsundergoingrevascularisationforrenalarterystenosis AT robpearson hypertensiveloadpredictsrecoveryofrenalfunctionforpatientsundergoingrevascularisationforrenalarterystenosis AT andrewjackson hypertensiveloadpredictsrecoveryofrenalfunctionforpatientsundergoingrevascularisationforrenalarterystenosis AT callumstove hypertensiveloadpredictsrecoveryofrenalfunctionforpatientsundergoingrevascularisationforrenalarterystenosis AT ramkasthuri hypertensiveloadpredictsrecoveryofrenalfunctionforpatientsundergoingrevascularisationforrenalarterystenosis AT keithhussey hypertensiveloadpredictsrecoveryofrenalfunctionforpatientsundergoingrevascularisationforrenalarterystenosis AT christiandelles hypertensiveloadpredictsrecoveryofrenalfunctionforpatientsundergoingrevascularisationforrenalarterystenosis AT colingeddes hypertensiveloadpredictsrecoveryofrenalfunctionforpatientsundergoingrevascularisationforrenalarterystenosis AT patrickmark hypertensiveloadpredictsrecoveryofrenalfunctionforpatientsundergoingrevascularisationforrenalarterystenosis AT gilesroditi hypertensiveloadpredictsrecoveryofrenalfunctionforpatientsundergoingrevascularisationforrenalarterystenosis AT linsaymccallum hypertensiveloadpredictsrecoveryofrenalfunctionforpatientsundergoingrevascularisationforrenalarterystenosis AT davidbkingsmore hypertensiveloadpredictsrecoveryofrenalfunctionforpatientsundergoingrevascularisationforrenalarterystenosis |