4–6 Meta-analysis of the 210 patients involved did show a minor reduction in the need for antihypertensive medication in those revascularized, although this benefit was not seen if the patient had pre-existing CKD. Benefits of revascularization seemed most marked in those with bilateral disease.54

Unfortunately, none of these trials, or ASTRAL, assessed RH as a specific group. There are non-randomized series reporting improvements in RH following renal artery revascularization. One included 25 patients with RH and 25 with RH and renal impairment. Forty-eight had successful procedures, with 83% receiving significant improvements in blood pressure over the follow-up period.55 A limitation of this data is that at 6 months, follow-up data were available only for 26 patients, and for only 14 patients at 36 months.

Opaganib clinical trial It is perhaps possible Smad inhibitor to extrapolate data from the DRASTIC RCT,6 where average patient baseline characteristics met the definition for RH. Although revascularization did not improve blood pressure control over the medical arm, there was a reduction in the number of antihypertensive agents required in the revascularization arm. It is conceivable that future analyses of the ASTRAL and Cardiovascular Outcomes in Renal Atherosclerotic Lesions (CORAL) data may further our knowledge in this issue. Until then revascularization in the setting of multidrug RH will remain largely an individualized choice. In the context of acute kidney injury precipitated by ARVD, revascularization seems a very appropriate intervention, and there are anecdotal reports of rescue from dialysis.

Most case reports describe patients with bilateral disease or a chronic unilateral renal artery occlusion (RAO) with a critical contralateral lesion.52,53,56 There is accumulating evidence that statin therapy could have beneficial effects on the rate of GFR decline in all cause CKD.57 Statin treatment has an established role in ARVD, possibly altering its natural history and slowing progression of stenosis. A retrospective analysis of 79 patients Liothyronine Sodium with ARVD undergoing angiographic follow up (mean interval 27 months) demonstrated regression in 12 patients. Of these, 10 were on statin therapy.58 Statins have pleiotropic effects with benefits not limited to reducing serum lipid concentrations. This is highlighted in follow up of 104 patients with ARVD over an 11 year period. In total, 68 received statin therapy, and 36 (with a normal lipid profile) did not. Statin treatment markedly improved both renal and patient survival (overall mortality 5.9% vs 36.1%).59 This may be due to reduced renal fibrosis in the statin-treated group secondary to upregulation of inhibitors of transforming growth factor-beta signalling – a phenomenon that has been demonstrated in ex vivo pigs.