Información de la revista
Vol. 32. Núm. 4.julio 2012
Páginas 0-553
Vol. 32. Núm. 4.julio 2012
Páginas 0-553
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Nefropatía isquémica: patogénesis y tratamiento
Ischemic nephropathy ¿ pathogenesis and treatment
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13590
Marcin Adamczaka, Andrzej Wieceka
a Department of Nephrology, Endocrinology and Metabolic Diseases, Medical University of Silesia, Katowice, Poland,
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En esta revisión nos gustaría realizar un resumen del conocimiento actual sobre la patogénesis y el tratamiento de la nefropatía isquémica. Los datos epidemiológicos sugieren que la prevalencia de la nefropatía isquémica aumenta, especialmente en los individuos de mayor edad. La patogénesis de esta enfermedad es más compleja que el mero estrechamiento de la arteria renal a causa de la ateroesclerosis. El sistema renina angiotensina, los factores de crecimiento, las diferentes citoquinas y las quimiocinas pueden estar implicados en la patogénesis de la nefropatía isquémica. Específicamente, los criterios diagnósticos de utilidad clínica de la nefropatía isquémica aún están por determinar. La gestión médica acordada de forma conjunta sigue siendo por el momento la principal opción terapéutica para la mayoría de los pacientes con esta patología y hoy en día, la revascularización está indicada únicamente en pacientes seleccionados.

Palabras clave:
Angioplastia renal
Palabras clave:
Tratamiento médico
Palabras clave:
Estenosis de la arteria renal
Palabras clave:
Enfermedad renal crónica
Palabras clave:
Nefropatía isquémica

In this review paper we would like to summarized the current knowledge concerning the  pathogenesis and treatment of ischemic nephropathy. Epidemiological data suggest that the prevalence of ischemic nephropathy increases, especially among older individuals. The pathogenesis of this disease is more complex than just narrowing of the renal artery due to atherosclerosis. Renin-angiotension system, growth factors, different cytokines and chemokines may participate in the pathogenesis of ischemic nephropathy. Precise, clinically useful diagnostic criteria of the ischemic nephropathy have not been established, yet. Concerted medical management remains now the main therapeutic option for majority of patients with this disease and only in the selected patients revascularisation is nowadays indicated.

Keywords:
Renal angioplasty
Keywords:
Medical therapy
Keywords:
Renal artery stenosis
Keywords:
Chronic kidne disease
Keywords:
Ischemic nephropathy
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Bibliografía
[1]
Kuroda S, Nishida N, Uzu T, Takeji M, Nishimura M, Fujii T, et al. Prevalence of renal artery stenosis in autopsy patients with stroke. Stroke 2000;31:61-5. [Pubmed]
[2]
MacDowall P, Kalra PA, O¿Donoghue DJ, Waldek S, Mamtora H, Brown K. Risk of morbidity from renovascular disease in elderly patients with congestive cardiac failure. Lancet 1988;352:13-6. [Pubmed]
[3]
Louie J, Isaacson JA, Zierler RE, Bergelin RO, Strandness DE Jr. Prevalence of carotid and lower extremity arterial disease in patients with renal artery stenosis. Am J Hypertens 1994;7:436-9. [Pubmed]
[4]
Kalra PA, Guo H, Kausz AT, Gilbertson DT, Liu J, Chen SC, et al. Atherosclerotic renovascular disease in United States patients aged 67 years or older: Risk factors, revascularization, and prognosis. Kidney Int 2005;68:293-301. [Pubmed]
[5]
Conlon PJ, Athirakul K, Kovalik E, Schwab SJ, Crowley J, Stack R, et al. Survival in renal vascular disease. J Am Soc Nephrol 1998;9:252-6. [Pubmed]
[6]
Conlon PJ, Little MA, Pieper K, Mark DB. Severity of renal vascular disease predicts mortality in patients undergoing coronary angiography. Kidney Int 2001;60:1490-7. [Pubmed]
[7]
Johansson M, Herlitz H, Jensen G, Rundqvist B, Friberg P. Increased cardiovascular mortality in hypertensive patients with renal artery stenosis. Relation to sympathetic activation, renal function and treatment regimens. J Hypertens 1999;17:1743-50. [Pubmed]
[8]
Mailloux LU, Bellucci AG, Mossey RT, Napolitano B, Moore T, Wilkes BM, et al. Predictors of survival in patients undergoing dialysis. Am J Med 1988;84:855-62. [Pubmed]
[9]
Scoble JE, Maher ER, Hamilton G, Dick R, Sweny P, Moorhead JF. Atherosclerotic renovascular disease causing renal impairment¿a case for treatment. Clin Nephrol 1989;31:119-22. [Pubmed]
[10]
Appel RG, Bleyer AJ, Reavis S, Hansen KJ. Renovascular disease in older patients beginning renal replacement therapy. Kidney Int 1995;48:171-6. [Pubmed]
[11]
van Ampting JM, Penne EL, Beek FJ, Koomans HA, Boer WH, Beutler JJ. Prevalence of atherosclerotic renal artery stenosis in patients starting dialysis. Nephrol Dial Transplant 2003;18:1147-51. [Pubmed]
[12]
Mailloux LU, Napolitano B, Bellucci AG, Vernace M, Wilkes BM, Mossey RT. Renal vascular disease causing end-stage renal disease, incidence, clinical correlates, and outcomes: A 20-year clinical experience. Am J Kidney Dis 1994;24:622-9. [Pubmed]
[13]
Fatica RA, Port FK, Young EW. Incidence trends and mortality in end-stage renal disease attributed to renovascular disease in the United States. Am J Kidney Dis 2001;37:1184-90. [Pubmed]
[14]
Dean RH, Kieffer RW, Smith BM, Oates JA, Nadeau JH, Hollifield JW, et al. Renovascular hypertension: Anatomic and renal function changes during drug therapy. Arch Surg 1981;116:1408-15. [Pubmed]
[15]
Schreiber MJ, Pohl MA, Norvick AC. The natural history of atherosclerotic and fibrous renal artery disease. Urol Clin North Am 1984;11:383-92. [Pubmed]
[16]
Caps MT, Zierler RE, Polissar NL, Bergelin RO, Beach KW, Cantwell-Gab K, et al. Risk of atrophy in kidneys with atherosclerotic renal artery stenosis. Kidney Int 1998;53:735-42. [Pubmed]
[17]
Shanley PF. The pathology of chronic renal ischemia. Semin Nephrol 1996;16:21-32. [Pubmed]
[18]
Greco BA, Breyer JA. Atherosclerotic ischemic renal disease. Am J Kidney Dis 1997;29:167-87. [Pubmed]
[19]
Keddis MT, Garovic VD, Bailey KR, Wood CM, Raissian Y, Grande JP.  Ischaemic nephropathy secondary to atherosclerotic renal artery stenosis: clinical and histopathological correlates. Nephrol Dial Transplant 2010;25:3615-22. [Pubmed]
[20]
Daemen MA, van 't Veer C, Denecker G, Heemskerk VH, Wolfs TG, Clauss M, et al. Inhibition of apoptosis induced by ischemia-reperfusion prevents inflammation. J Clin Invest 1999;104:541-9. [Pubmed]
[21]
Gobe GC, Axelsen RA, Searle JW. Cellular events in experimental unilateral ischemic renal atrophy and in regeneration after contralateral nephrectomy. Lab Invest 1990;63:770-9. [Pubmed]
[22]
Meyrier A, Hill GS, Simon P. Ischemic renal diseases: new insights into old entities. Kidney Int 1998;54:2-13. [Pubmed]
[23]
Moran K, Mulhall J, Kelly D, Dowsett J, Dervan P, Fitzpatrick JM. Morphological changes and alterations in regional intrarenal blood flow induced by graded renal ischemia. J Urol 1992;148:463-6. [Pubmed]
[24]
Lerman LO, Schwartz RS, Grande JP, Sheedy PF, Romero JC. Noninvasive evaluation of a novel swine model of renal artery stenosis. J Am Soc Nephrol 1999;10:1455-65. [Pubmed]
[25]
Meyrier A. Renal vascular lesions in the elderly: nephrosclerosis or atheromatous renal disease? Nephrol Dial Transplant 1996;11:45-52. [Pubmed]
[26]
Basile DP, Donohoe D, Roethe K, Osborn JL. Renal ischemic injury results in permanent damage to peritubular capillaries and influences longterm function. Am J Physiol Renal Physiol 2001;281:F887-99. [Pubmed]
[27]
Levy BI, Schiffrin EL, Mourad JJ, Agostini D, Vicaut E, Safar ME, et al. Impaired tissue perfusion: a pathology common to hypertension, obesity, and diabetes mellitus. Circulation 2008;118:968-76. [Pubmed]
[28]
Kang DH, Kanellis J, Hugo C, Truong L, Anderson S, Kerjaschki D, et al. Role of the microvascular endothelium in progressive renal disease. J Am Soc Nephrol 2002;13:806-16. [Pubmed]
[29]
Wright JR, Duggal A, Thomas R, Reeve R, Roberts IS, Kalra PA. Clinicopathological correlation in biopsy-proven atherosclerotic nephropathy: implications for renal functional outcome in atherosclerotic renovascular disease. Nephrol Dial Transplant 2001;16:765-70. [Pubmed]
[30]
Suresh M, Labboi P, Mamtora H, Kalra PA. Relationship of renal dysfunction to proximal arterial disease severity in atherosclerotic renovascular disease. Nephrol Dial Transplant 2000;15:631-6. [Pubmed]
[31]
Cheung CM, Wright JR, Shurrab AE, Mamtora H, Foley RN, O¿Donoghue DJ, et al. Epidemiology of renal dysfunction and patient outcome in atherosclerotic renal artery occlusion. J Am Soc Nephrol 2002;13:149-57. [Pubmed]
[32]
Warner L, Gomez SI, Bolterman R, Haas JA, Bentley MD, Lerman LO, et al. Regional decreases in renal oxygenation during graded acute renal arterial stenosis: a case for renal ischemia. Am J Physiol Regul Integr Comp Physiol 2009;296:R67-71. [Pubmed]
[33]
Simon-Zoula SC, Hofmann L, Giger A, Vogt B, Vock P, Frey FJ, et al. Noninvasive monitoring of renal oxygenation using BOLD-MRI: a reproducibility study. NMR Biomed 2006;19:84-9. [Pubmed]
[34]
Artunc F,  Rossi C, Boss A. MRI to assess renal structure and function. Curr Opin Nephrol Hypertens 2011;20:669-75.  [Pubmed]
[35]
Gloviczki ML, Glockner JF, Lerman LO, McKusick MA, Misra S, Grande JP, et al. Preserved oxygenation despite reduced blood flow in poststenotic kidneys in human atherosclerotic renal artery stenosis. Hypertension 2010;55:961-6. [Pubmed]
[36]
Nielsen K, Rehling M, Henriksen JH. Renal vein oxygen saturation in renal artery stenosis. Clin Physiol 1992;12:179-84. [Pubmed]
[37]
Wiecek A, Kokot F, Kuczera M, Grzeszczak W, Kiersztejn M. Plasma erythropoietin concentrations in renal venous blood of patients with unilateral renovascular hypertension. Nephrol Dial Transplant 1992;7:221-4. [Pubmed]
[38]
Nangaku M. Chronic hypoxia and tubulointerstitial injury: a final common pathway to end-stage renal failure. J Am Soc Nephrol 2006;17:17-25. [Pubmed]
[39]
De Bruyne B, Manoharan G, Pijls NHJ, Verhamme K, Madaric J, Bartunek J, et al. Assessment of renal artery stenosis severity by pressure gradient measurements. J Am Coll Cardiol 2006;48:1851-5. [Pubmed]
[40]
Lerman LO, Textor SC, Grande JP. Mechanisms of tissue injury in renal artery stenosis: ischemia and beyond. Prog Cardiovasc Dis 2009;52:196-203. [Pubmed]
[41]
Lerman LO, Nath KA, Rodriguez-Porcel M, Krier JD, Schwartz RS, Napoli C, et al. Increased oxidative stress in experimental renovascular hypertension. Hypertension 2001;37:541-6. [Pubmed]
[42]
Higashi Y, Sasaki S, Nakagawa K, Matsuura H, Oshima T, Chayama K. Endothelial function and oxidative stress in renovascular hypertension. N Engl J Med 2002;346:1954-62. [Pubmed]
[43]
Minuz P, Patrignani P, Gaino S, Degan M, Menapace L, Tommasoli R, et al. Increased oxidative stress and platelet activation in patients with hypertension and renovascular disease. Circulation 2002;106:2800-5. [Pubmed]
[44]
Schnackenberg CG. Physiological and pathophysiological roles of oxygen radicals in the renal microvasculature. Am J Physiol Regul Integr Comp Physiol 2002;282:R335-42. [Pubmed]
[45]
Chade AR, Zhu X, Lavi R, Krier JD, Pislaru S, Simari RD, et al. Endothelial progenitor cells restore renal function in chronic experimental renovascular disease. Circulation 2009;119:547-57. [Pubmed]
[46]
Makanjuola AD, Suresh M, Laboi P, Kalra PA, Scoble JE. Proteinuria in atherosclerotic renovascular disease. QJM 1999;92:515-8. [Pubmed]
[47]
Zhu XY, Chade AR, Rodriguez-Porcel M, Bentley MD, Ritman EL, Lerman A, et al. Cortical microvascular remodeling in the stenotic kidney: role of increased oxidative stress. Arterioscler Thromb Vasc Biol 2004;24:1854-9. [Pubmed]
[48]
Chade AR, Zhu XY, Grande JP, Krier JD, Lerman A, Lerman LO. Simvastatin abates development of renal fibrosis in experimental renovascular disease. J Hypertens 2008;26:1651-60. [Pubmed]
[49]
Iliescu R, Fernandez SR, Kelsen S, Maric C, Chade AR. Role of renal microcirculation in experimental renovascular disease. Nephrol Dial Transplant 2010;25:1079-87. [Pubmed]
[50]
Chade AR, Zhu XY, Krier JD, Jordan KL, Textor SC, Grande JP, et al. Endothelial progenitor cells homing and renal repair in experimental renovascular disease. Stem Cells 2010;28:1039-47. [Pubmed]
[51]
Wiecek A, Chudek J, Adamczak M. Indications for renal revascularization - the landscape after the ASTRAL study. Nephrol Dial Transplant 2010;25:2399-402. [Pubmed]
[52]
Greco BA, Breyer JA. Atherosclerotic ischemic renal disease. Am J Kidney Dis 1997;29:167-87. [Pubmed]
[53]
Radermacher J, Chavan A, Bleck J, Vitzthum A, Stoess B, Gebel MJ, et al. Use of Doppler ultrasonography to predict the outcome of therapy for renal-artery stenosis. N Engl J Med 2001;344:410-7. [Pubmed]
[54]
García-Criado A, Gilabert R, Nicolau C, Real MI, Munta¿á X, Blasco J, et al. Value of Doppler sonography for predicting clinical outcome after renal artery revascularization in atherosclerotic renal artery stenosis. J Ultrasound Med 2005;24:1641-7. [Pubmed]
[55]
Chrysochou C, Mendichovszky IA, Buckley DL, Cheung CM, Jackson A, Kalra PA. BOLD imaging: a potential predictive biomarker of renal functional outcome following revascularization in atheromatous renovascular disease. Nephrol Dial Transplant 2012 [in press]. [Pubmed]
[56]
Textor SC, Glockner JF, Lerman LO, Misra S, McKusick MA, Riederer SJ, et al. The use of magnetic resonance to evaluate tissue oxygenation in renal artery stenosis. J Am Soc Nephrol 2008;19:780-8. [Pubmed]
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