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2016 ; 31
(9
): 1437-43
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Changes in inflammatory biomarkers after renal revascularization in
atherosclerotic renal artery stenosis
#MMPMID26908767
Wang W
; Saad A
; Herrmann SM
; Eirin Massat A
; McKusick MA
; Misra S
; Lerman LO
; Textor SC
Nephrol Dial Transplant
2016[Sep]; 31
(9
): 1437-43
PMID26908767
show ga
BACKGROUND: Atherosclerotic renal artery stenosis (ARAS) activates oxidative
stress and chronic inflammatory injury. Contrast imaging and endovascular
stenting pose potential hazards for acute kidney injury, particularly when
superimposed upon reduced kidney perfusion. METHODS: We measured sequential early
and long-term changes in circulating inflammatory and injury biomarkers in 12
ARAS subjects subjected to computed tomography imaging and stent
revascularization compared with essential hypertensive (EH) subjects of similar
age under fixed sodium intake and medication regimens in a clinical research
unit. RESULTS: NGAL, TIMP-2, IGFBP7, MCP-1 and TNF-? all were elevated before
intervention. Post-stenotic kidney volume, perfusion, blood flow and glomerular
filtration rate (GFR) were lower in ARAS than in EH subjects. TIMP-2 and IGFBP7
fell briefly, then rose over 18 h after contrast imaging and stent deployment.
Circulating NGAL decreased and remained lower for 27 h. These biomarkers in ARAS
returned to baseline after 3 months, while kidney volume, perfusion, blood flow
and GFR increased, but remained lower than EH. CONCLUSIONS: These divergent
patterns of inflammatory signals are consistent with cell cycle arrest (TIMP-2,
IGFBP7) and relative protection from acute kidney injury after imaging and
stenting. Sustained basal elevation of circulating and renal venous inflammatory
biomarkers support ongoing, possibly episodic, renal stress in ARAS that limits
toxicity from stent revascularization.