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Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

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Had quad by-pass surgery, ultrasound showed blockage, no stent in non functioning kidney. Should i be concerned?

My husband has had quad by-pass surgery and has had stent put into 1 of his kidneys, which now not functioning at all! They haven't removed the kidney and said they wouldn't unless it became a problem. My question is - he just went in day surgery to have a stent put into the good kidney. Ultrasound showed blockage, but when the Dr went to put cath in they said it wasn't has bad as they originally thought - so they didn't insert the stent. Should we be concerned - maybe get a 2nd opinion??
Thu, 18 Apr 2013
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Internal Medicine Specialist 's  Response
hi
Treatment options for the control of hypertension in patients of RENAL ARTERY STENOSIS(RAS) with atherosclerotic bilateral renal artery includes both medical and interventional therapy. Interventions aimed at preserving renal function in patients with bilateral renal artery stenosis

Antihypertensive drugs — For hypertension control, we recommend an ACE inhibitor or angiotensin II receptor blocker , often in combination with diuretic . Chlorthalidone is the preferred thiazide diuretic, but a loop diuretic (eg, furosemide or torsemide), may be required in patients who have chronic kidney disease with a significantly reduced glomerular filtration rate. Long-acting calcium channel blockers and beta blockers are also effective .

Interventional therapy — Percutaneous transluminal angioplasty with stenting is the preferred nonsurgical intervention. Three randomized trials, all with serious flaws, found no improvement in blood pressure, renal, or cardiovascular outcomes in patients with atherosclerotic renal artery stenosis who were treated with percutaneous transluminal angioplasty and stent placement.

We agree with the 2005 ACC/AHA guidelines on the management of peripheral artery disease, which recommended percutaneous transluminal angioplasty with stenting for ostial atherosclerotic lesions in patients who have clinical clues suggesting that the renovascular disease is likely to be responsible for hypertension that is not well controlled with optimal medical therapy

Based upon the available data, we recommend not performing percutaneous transluminal angioplasty in patients who do not meet these criteria because the likelihood of benefit is small and the risk of procedural complications is relatively high.
We agree with the 2005 ACC/AHA guidelines, which recommended surgery in patients with atherosclerotic renal artery stenosis who have clinical indications for revascularization, particularly if they have multiple small renal arteries, early primary branching of the main renal artery, or require aortic reconstruction near the renal arteries for other indications (eg, aneurysm repair or severe aortoiliac occlusive disease)
take care
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Cardiologist Dr. Anantharamakrishnan's  Response
Hi friend,
Welcome to Health Care Magic

I presume - the other stent is related to the renal artery? not in ureter!?
Unless the obstruction is significant, a stent may not be appropriate and hence the decision /
In ultra sound, one sees the shadow / in intervention, the actual substance.....
A second opinion will certainly clarify...

Take care
Wishing speedy recovery
God bless
Good luck
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Had quad by-pass surgery, ultrasound showed blockage, no stent in non functioning kidney. Should i be concerned?

hi Treatment options for the control of hypertension in patients of RENAL ARTERY STENOSIS(RAS) with atherosclerotic bilateral renal artery includes both medical and interventional therapy. Interventions aimed at preserving renal function in patients with bilateral renal artery stenosis Antihypertensive drugs — For hypertension control, we recommend an ACE inhibitor or angiotensin II receptor blocker , often in combination with diuretic . Chlorthalidone is the preferred thiazide diuretic, but a loop diuretic (eg, furosemide or torsemide), may be required in patients who have chronic kidney disease with a significantly reduced glomerular filtration rate. Long-acting calcium channel blockers and beta blockers are also effective . Interventional therapy — Percutaneous transluminal angioplasty with stenting is the preferred nonsurgical intervention. Three randomized trials, all with serious flaws, found no improvement in blood pressure, renal, or cardiovascular outcomes in patients with atherosclerotic renal artery stenosis who were treated with percutaneous transluminal angioplasty and stent placement. We agree with the 2005 ACC/AHA guidelines on the management of peripheral artery disease, which recommended percutaneous transluminal angioplasty with stenting for ostial atherosclerotic lesions in patients who have clinical clues suggesting that the renovascular disease is likely to be responsible for hypertension that is not well controlled with optimal medical therapy Based upon the available data, we recommend not performing percutaneous transluminal angioplasty in patients who do not meet these criteria because the likelihood of benefit is small and the risk of procedural complications is relatively high. We agree with the 2005 ACC/AHA guidelines, which recommended surgery in patients with atherosclerotic renal artery stenosis who have clinical indications for revascularization, particularly if they have multiple small renal arteries, early primary branching of the main renal artery, or require aortic reconstruction near the renal arteries for other indications (eg, aneurysm repair or severe aortoiliac occlusive disease) take care