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Impact of renal artery stent implantation on hypertension in patients with hemodialysis.

ABSTRACT: The benefit from renal artery stent implantation to treat atherosclerotic renal artery stenosis (ARAS) is not well understood in hemodialysis patients. We sought to evaluate the effects of renal artery stenting on hypertension of hemodialysis patients. Renal artery stent implantation was successfully performed on eight hypertensive hemodialysis patients with ARAS (mean ± SD, 66 ± 10 years; men 6, women 2). Blood pressure was measured by automated oscillometric recordings just before hemodialysis. Mean values of the blood pressure, measured 12 times a month, were used for blood pressure analysis. Values of systolic blood pressure decreased at 6 months after renal artery stent implantation (162.6 ± 29.7 to 121.1 ± 23.3 mm Hg, p = 0.0015). Values of diastolic blood pressure also decreased from 77.6 ± 13.6 to 65.6 ± 7.2 mm Hg (p = 0.02). Renal artery stent implantation for ARAS had a beneficial effect on hypertension in hemodialysis patients.

SUBMITTER: Hikita H

PROVIDER: S-EPMC4082453 | biostudies-other | 2014 Jun

REPOSITORIES: biostudies-other

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Project description:BackgroundPsychosocial stress and activation of neutrophil granulocytes are increasingly recognized as major risk factors of coronary artery disease (CAD), but the possible relationship of these two factors in CAD patients is largely unexplored. Activation of neutrophils was reported to be associated with stenting; however, the issue of neutrophil state in connection with percutaneous coronary intervention (PCI) is incompletely understood from the aspect of stress and its hypothalamic-pituitary-adrenal axis (HPA) background. Thus, we aimed to study cortisol- and ACTH-associated changes in granulocyte activation in patients undergoing PCI.Methodology/principal findingsBlood samples of 21 stable angina pectoris (SAP) and 20 acute coronary syndrome (ACS) patients were collected directly before (pre-PCI), after (post-PCI) and on the following day of PCI (1d-PCI). Granulocyte surface L-selectin, CD15 and (neutrophil-specific) lactoferrin were analysed by flow cytometry. Plasma cortisol, ACTH, and lactoferrin, IL-6 were also assayed. In both groups, pre- and post-PCI ratios of lactoferrin-bearing neutrophils were relatively high, these percentages decreased substantially next day; similarly, 1d-PCI plasma lactoferrin was about half of the post-PCI value (all p?0.0001). Post-PCI ACTH was reduced markedly next day, especially in ACS group (SAP: p<0.01, ACS: p?0.0001). In ACS, elevated pre-PCI cortisol decreased considerably a day after stenting (p<0.01); in pre-PCI samples, cortisol correlated with plasma lactoferrin (r?0.5, p<0.05). In 1d-PCI samples of both groups, ACTH showed negative associations with the ratio of lactoferrin-bearing neutrophils (SAP: r?=?-0.601, p<0.005; ACS: r?=?-0.541, p<0.05) and with plasma lactoferrin (SAP: r?=?-0.435, p<0.05; ACS: r?=?-0.609, p<0.005).Conclusions/significancePre- and post-PCI states were associated with increased percentage of activated/degranulated neutrophils indicated by elevated lactoferrin parameters, the 1d-PCI declines of which were associated with plasma ACTH in both groups. The correlation of plasma cortisol with plasma lactoferrin in the extremely stressed ACS before stenting, however, suggests an association of cortisol with neutrophil activation.

Project description:BackgroundPancreatic portal hypertension (PPH) is a type of extrahepatic portal hypertension. We compared the clinical efficacy of different treatment methods for PPH caused by splenic vein stenosis in chronic pancreatitis.MethodsThis article retrospectively analyzed the PPH cases that were caused by splenic vein stenosis after chronic pancreatitis. Patients were divided into three groups according to the different treatments: splenic vein stent implantation (stent group), splenectomy, and only medications (conservative group). The treatment effects from each group were compared.ResultsA total of 33 patients were retrospectively analyzed in this study (9, 12, and 12 patients in each group respectively). All the procedures were successful in the stent and splenectomy groups. During the follow-up, no patient had gastrointestinal bleeding recurrence in the stent and splenectomy groups. However, in the conservative group, the incidence of portal hypertensive gastropathy and upper gastrointestinal bleeding were 50% and 25%. In the stent group, all the varicose veins at the base of the stomach had shrunk by varying degrees, and the red color signs regressed. The stent patency rate was 100%. No major complication occurred. The average platelet count at 1, 3, 6-months postoperatively were all significantly higher than the preoperative value (P < 0.05). The average postoperative hospital stay duration was significantly shorter than that of the splenectomy group (3.1 ± 1.4 days vs. 16.1 ± 8.1 days; P < 0.05). In the splenectomy group, postoperative fever occurred in 4 patients. Postoperative infection occurred in 2 patients (one with abdominal cavity infection and the other with incision infection). Delayed abdominal bleeding occurred in one patient. Portal vein thrombosis occurred in 2 patients during follow up.ConclusionPercutaneous splenic vein stent implantation for PPH treatment reduces the risk of gastrointestinal bleeding with minimal invasive. It has a high safety and reliable efficacy and is worthy of further clinical promotion.

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Impact of renal artery stent implantation on hypertension in patients with hemodialysis.

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