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Surgery Not Always Best for Narrowed Kidney Arteries
Date:11/11/2009

oes or legs amputated, the study noted.

The most common cause of atherosclerotic renovascular disease is the build-up of plaque on the inside of the arteries that supply blood to the kidneys, causing them to narrow and stiffen, or harden. This can lead to high blood pressure and, eventually, severe kidney damage.

Kalra said, though, that certain people can benefit from revascularization, including those with heart failure and people whose kidney function is rapidly worsening.

Dr. Ajay Singh, clinical director of the renal division and director of dialysis at Brigham and Women's Hospital in Boston and an associate professor of medicine at Harvard Medical School, said that renal artery stenosis, or narrowing of the arteries, is thought to be present in 1 percent to 2 percent of the 25 million Americans with high blood pressure.

Data from 2000 show that nearly 20,000 renal angioplasties, the artery-opening surgeries, are performed each year in the United States at a cost of more than $200 million -- a figure that is "likely to be much higher now, nine years later," Singh said.

But he said only limited information exists on whether angioplasties actually make a difference in preserving kidney function and controlling blood pressure.

"This study would suggest not," he said. "While we are awaiting a bigger study from the U.S. National Institutes of Health, called CORAL, all the evidence so far points to treating patients with blood pressure medications rather than balloon angioplasty."

However, Dr. Arif Asif, director of interventional nephrology at the University of Miami Miller School of Medicine, said that the study had a limitation that makes it difficult to really decide which treatment is best.

The limitation was that people were enrolled based on their doctor's discretion, he said. Because of that, Asif said, people who doctors felt would benefit from angioplasty were excluded from th
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