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Renal stenosis, fluctuating BP, kidney damage. High creatinine levels. Should angiography be done?

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Nephrologist
Practicing since : 2000
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my father is being dtected renal stenosis and his creatininine levels is for past 10 been between 1.9 -3.5. Should he be done angiography/angioplasty? Can you speculate how much kidney is damaged, from this information? HE IS IN ICU for past 4 days and his bp is fluctuating between 115-170.
Posted Sun, 15 Apr 2012 in Kidney Conditions
 
 
Answered by Dr. Dilip M Babu 22 hours later
Hi,
Thanks for posting your query.

Your father is having secondary hypertension due to creatinine levels are high. Creatinine levels will go up after 70 to 80 percent kidneys are damaged.
Doing angiography or angioplasty will be risky at this stage as contrast XXXXXXX may cause further damage to the kidneys.
I think it would be advisable to control the blood pressure first and monitor creatinine levels regularly. Angiography or angioplasty will be planned afterwards if the patient has resistant hypertension not controlled with multiple drugs.
The outcome of renal artery stenosis with medical management vs angioplasty will be same.

I hope I have answered your query. Please accept my answer if you have no further follow up queries.

Thanks
Above answer was peer-reviewed by
 
Follow-up: Renal stenosis, fluctuating BP, kidney damage. High creatinine levels. Should angiography be done? 39 minutes later
Dear Sir,

Thanks for your reply.
1] As you said 'Creatinine levels will go up after 70 to 80 percent kidneys are damaged' . Does that mean his kidneys are already damaged 70-80 percent?

2] He went under MR Angiography in the morning today [28th] [as directed by Nephrologist here] and the Nephrologist has planned DTP tomorrow [29th] once his creatinine level comes down. According to Nephrologist here, unlike 'CT SCAN dye', the MR XXXXXXX and DTP dyes don't damage the kidneys. Is it true? Are these tests advisable this stage?

3] As you said 'The outcome of angioplasty will be same.' Should we ask the doctor to not do angiography/angioplasty?
I am also attaching case history herewith.

With thanks XXXXXXX
 
 
Answered by Dr. Dilip M Babu 21 hours later
Hi,
Thanks for reverting.

Your father's creatinine level is 1.9 to 3.5. If his creatinine levels have gone up recently, it is suggestive of temporary kidney damage [70 to 80 %] and it should recover with treatment. Creatinine is a poor marker of kidney function. The estimated glomerular filtration rate (eGFR) will give an accurate idea of the kidney function [which can be calculated in patients with stable kidney function].

MR angiography with use of XXXXXXX like gadolinium should not be done in patients with high creatinine value as it may cause severe disease like nephrogenic systemic fibrosis. DTP XXXXXXX will not cause kidney damage but it will not be helpful at this high creatinine levels.

Till date, no study has shown angioplasty to produce better outcomes as compared to medical management of hypertension. Angioplasty is advised only in case of resistant hypertension to reduce the number of antihypertensive medications.

I hope I have answered your query. Please accept my answer if you have no further queries.
Thanks


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