Hatem Hamdan Salaheen Abbadi.
Bilateral Renal Artery Stenosis - an incidental finding during Cardiac Catheterization - Review of 15 cases of BRAS stenting at Queen Alia Heart Institute in Jordan.
Pak J Med Sci Jan ;21(4):426-32.

Objective: To review the clinical patterns, associated features, in 15 cases of Bilateral Renal Artery Stenosis (BRAS) who underwent Bilateral Renal Artery stenting. Work Place: King Hussein Medical Centre & Queen Alia Heart Institute, Amman, Jordan. Methods: We studied patients who had routine renal angiogram during cardiac catheterization for coronary or valve diseases between January 2000 and December 2004. A total of 15 patients had significant bilateral renal artery stenosis who underwent bilateral renal artery stenting. Files were retrieved, clinical and laboratory reviews were done. Unilateral renal stenting cases were excluded. All data were collected and analyzed for individual patient, considering age, risk factors, kidney function test, lipid profile, clinical presentation, severity of coronary artery disease and left ventricle dysfunction. Associated atheromatous vascular diseases and special attention to usage of Angiotensin Converting Enzyme Inhibitors (ACEIs). Results: Two third were male and 80% were hypertensive, 46% had diabetes and the mean age was 64.4 year. 86% of patients had significant coronary artery disease (13 patients), 6 of them had coronary bypass. Only 2 patients had level of creatinine >2mg/dl while the others had normal level. Taking clinical presentation into consideration, 6 had myocardial infarction, angina also in another 6 patients, 3 presented with pulmonary edema. Bilateral renal artery stenting done with 93% success, one of our patients died after surgery. Conclusion: Bilateral renal artery stenosis can be an incidental finding during cardiac catherization. Bilateral RAS can occur in patients with little or no hypertension and even normal kidney function. It is commonly associated with coronary artery disease. Bilateral renal artery stenting would decrease progression to ischemic nephropathy and improve cardiac symptoms like pulmonary edema angina and allow usage of angiotensin converting enzyme inhibitors safely in addition to surgery with no renal complications.

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