Renal Failure

[Guest]

Hi my father is suffering from renal stenosis and he is 63. He also has aortic stenosis. CUrrently Kidney function has dropped sharply with serum creatine reaching 2.8 and blood urea rising upto 60.
Doctors in India are hesitating to go for Angiogram-Angioplasty, since there is a risk of failure of angiogram at this age. If it fails, the only option is to go for dialysis or nephrectomy. Dcotors are divided in advising to go for angiogram-angioplasty. My question is: whether anyone can direct me reg. age related risk in going for angiogram to clear renal artery stenosis. Any other suggestion towards this are welcome.
I really appreciate it.

[Guest]

Unfortunately we still do not know the best approach for treatment of RAS. Each patient must be evaluated indivdually. Some general comments:

3 options for Rx
Medical therapy: control BP
Angioplasty and STENTING (in general all proximal RAS should be stented)
Surgical Bypass

If the kidney is less than 8cm in size it may not be worth intervening and medical theerapy may be best options.

Strict BP comntrol and cholesterol control. Avoid Nephrotoxic drugs. No tobacco.

In general revascularization of the kidney by surgery or stenting often protects the kidney so it will last longer but there is a risk of making things worsse.

The non-stenotic kidney often is damage by HTN and if the Scr is 2.8 thne both kidney are impaired.

Often one can monitor the kideny size over time by U/s to see ifit is getting smaller along with kidney function CrCL.

Non-invasive Dx of RAS by MRi/MRA is becoming the best test.

Give mucomyst prior to ngiogram to help decrease the risk of contrast induced Nephrotoxicity.
[quote] Hi my father is suffering from renal stenosis and he is 63. He also has aortic stenosis... [/quote]