How To Choose Drugs And Interventional Treatments For Ischemic Nephropathy Caused By Atherosclerosis?

Uncle Wang, who is 82 years old this year, has a history of type 2 diabetes and hypertension for many years. He usually has poor blood sugar and blood pressure control. During his physical examination this year, he found abnormal kidney function, with blood creatinine of 172 μmol/L. He heard from his neighbor that high creatinine was probably due to uremia, and he might have to rely on hemodialysis for the rest of his life. He was so frightened that he quickly admitted himself to the Nephrology Department of our hospital.

Click to Cistanche for kidney disease

During the comprehensive examination, it was found that the left side of Uncle Wang's kidney was slightly smaller than the right side, and the blood in the left renal artery was also abnormal. The blood vessels in other parts of the body, such as the lower extremity arteries, carotid arteries, and abdominal aorta, had varying degrees of atherosclerosis and plaque formation. After obtaining the consent of the patient and his family, CT reconstruction of both kidneys and renal arteries was performed. The results showed that the opening of Uncle Wang's left renal artery was severely stenotic. It turned out that the culprit of Uncle Wang's abnormal renal function was ischemia caused by arteriosclerosis. Kidney disease.

What is ischemic nephropathy?

Ischemic nephropathy specifically refers to the hemodynamic changes caused by renal artery stenosis (RAS) and causes a decrease in the glomerular filtration rate [1].

Common causes of renal artery stenosis include myofibrodysplasia, Takayasu arteritis, and atherosclerosis. Among patients over 40 years old, atherosclerotic renal artery stenosis (ARAS) accounts for as high as 94.7%. , which is closely related to the changes in people's lifestyle and diet in recent years and the aging of the population, especially closely related to the following factors: advanced age, smoking history, hyperlipidemia, diabetes, decreased renal function, etc., while muscle fiber dysplasia, multiple large arteries Inflammation is the main cause of disease in people under 40 years old [1, 2].

Clinical manifestations of ischemic nephropathy

The main clinical manifestation of ARAS is hypertension, which can manifest as new hypertension, aggravation of existing hypertension, or even malignant hypertension. The main manifestation of the kidney is chronic renal insufficiency. Some patients may have proteinuria, but generally, it does not exceed 1g/d. If hypertension progresses rapidly, the amount of proteinuria can increase significantly, and even proteinuria in the nephrotic range may occur. As blood pressure is controlled, proteinuria also decreases.

How to Diagnose Ischemic Kidney Disease

digital subtraction angiography         

It is the current gold standard for the diagnosis of renal artery stenosis. It can clearly display the anatomical structure of the renal artery and reflect the location, extent, and scope of the disease. It is the preferred detection method for patients with refractory hypertension and severe renal insufficiency who undergo pre-interventional treatment. However, the examination is expensive and somewhat invasive, and injecting contrast media may cause contrast nephropathy and aggravate renal ischemia.

Renal artery ultrasound   

It is a universal first-line screening that can assess the degree and location of stenosis. It has the advantages of being non-invasive, safe, and convenient, but it is easily affected by many factors such as breathing, obesity, intestinal gas, degree of stenosis, instrument quality, and operator experience. Duplex ultrasound can not only evaluate the anatomical structure of the renal artery, but also display blood flow changes, and its sensitivity in detecting RAS is significantly higher than that of renal artery ultrasound.

Renal artery tomography (CTA)     

This method has a sensitivity and specificity of >90%, clearly displays the renal artery and accessory renal artery, and the reconstructed image can be displayed in three dimensions and has been widely used in clinical practice. However, CTA requires the use of iodine-containing contrast media. When the creatinine clearance rate (eGFR) is <60ml/min, preparations must be made to prevent contrast-induced nephropathy. Use this method with caution when eGFR is <30ml/min. Be careful with severe hyperthyroidism and iodine-containing contrast media. Contraindicated in patients with allergies.

In addition, there are magnetic resonance angiography (MRA), lateral renal vein renin activity measurement (RVRR), lateral renal vein renin activity measurement (RVRR), and other examinations. Each has its own imaging characteristics, advantages and disadvantages, and can all be used to diagnose RAS. [3].

Treatment of ischemic nephropathy

The treatment of ARAS is divided into drug therapy and renal revascularization therapy, that is, interventional therapy (including percutaneous renal angioplasty and stent placement).

Clinical evidence shows that for any degree of ARAS, treatment should be based on pharmacotherapy, including antihypertensives, control of dyslipidemia, and platelet inhibition. Angiotensin-converting enzyme inhibitors (ACEI) and angiotensin II receptor blockers (ARB) are still the most recommended drugs for ARAS.

However, in patients with bilateral renal ischemia, ACEI/ARB may cause acute renal insufficiency. If obvious renal dysfunction occurs after taking the drug, such as a rapid increase in serum creatinine exceeding 0.5 mg/dl or a decrease in eGFR exceeding 30% of the baseline value. , use of the drug should be suspended.

In addition, β-blockers can inhibit renin release and can be used; diuretics activate renin release and are generally not recommended for renovascular hypertension. However, if combined with essential hypertension, pulmonary edema or heart failure, Still available.

A large number of meta-analyses have proven that there is no statistically significant difference between the renal artery stent revascularization group and drug treatment in terms of improving blood pressure or slowing down the decline of renal function between the two groups.

Indications for interventional therapy

1. Recurrent congestive heart failure without obvious cardiac cause;

2. Bilateral stenosis or stenosis on the solitary renal function side;

3. People with bilateral stenosis or isolated renal stenosis with a rapid decline in renal function in the past 3 to 6 months without other obvious reasons;

4. Hypertension that is difficult to control with medication (at least three or more antihypertensive drugs including diuretics at the maximum dose).

In summary, before making a therapeutic decision for revascularization of renal artery stenosis, the patient's comorbidities, blood pressure control, and renal function level should be fully clarified.

For the elderly, those with basic medical diseases such as diabetes, hypertension, coronary heart disease, and severe systemic arteriosclerosis, conservative treatment with drugs is recommended, because these patients have a higher risk of undergoing stent implantation, and the blood vessels at the unstent site are prone to The stenosis reappeared and the stent was less effective.

In view of the above understanding of various aspects of ARAS, combined with Uncle Wang's own situation, and that he has no history of recurrent heart failure, it is recommended that the patient undergo conservative treatment with drugs. After continuous adjustment of the medication, the patient's blood sugar and blood pressure were controlled close to the target level, and the serum creatinine dropped and was stably maintained at 140-150 μmol/d. The patient and his family were very satisfied with the treatment effect.

How Does Cistanche Treat Kidney Disease?

Cistanche is a traditional Chinese herbal medicine used for centuries to treat various health conditions, including kidney disease. It is derived from the dried stems of Cistanche deserticola, a plant native to the deserts of China and Mongolia. The main active components of cistanche are phenylethanoid glycosides, echinacoside, and acteoside, which have been found to have beneficial effects on kidney health.

Kidney disease, also known as renal disease, refers to a condition in which the kidneys are not functioning properly. This can result in a buildup of waste products and toxins in the body, leading to various symptoms and complications. Cistanche may help treat kidney disease ase through several mechanisms.

Firstly, cistanche has been found to have diuretic properties, meaning it can increase urine production and help eliminate waste products from the body. This can help relieve the burden on the kidneys and prevent the buildup of toxins. By promoting diuresis, cistanche may also help Reduce high blood pressure, a common complication of kidney disease.

Moreover, cistanche has been shown to have antioxidant effects. Oxidative stress, caused by an imbalance between the production of free radicals and the body's antioxidant defenses, plays a key role in the progression of kidney disease. ies help neutralize free radicals and reduce Oxidative stress, thereby protecting the kidneys from damage. The phenylethanoid glycosides found in cistanche have been particularly effective in scavenging free radicals and inhibiting lipid peroxidation.

Additionally, cistanche has been found to have anti-inflammatory effects. Inflammation is another key factor in the development and progression of kidney disease. Cistanche's anti-inflammatory properties help reduce the production of pro-inflammatory cytokines and inhibit the activation of inflammation mandatory pathways, thus alleviating inflammation in the kidneys.

Furthermore, cistanche has been shown to have immunomodulatory effects. In kidney disease, the immune system can be dysregulated, leading to excessive inflammation and tissue damage. Cistanche helps regulate the immune response by modulating the production and activity of immune cells, such as T cells and macrophages. This immune regulation helps reduce inflammation and prevent further damage to the kidneys.

Moreover, cistanche has been found to improve renal function by promoting the regeneration of renal tubes with cells. Renal tubular epithelial cells play a crucial role in the filtration and reabsorption of waste products and electrolytes. In kidney disease, these cells can be damaged, leading to damaged renal function. Cistanche's ability to promote the regeneration of these cells helps restore proper renal function and improve overall kidney health.

In addition to these direct effects on the kidneys, cistanche has been found to have beneficial effects on other organs and systems in the body. This holistic approach to health is particularly important in kidney disease, as the condition often affects multiple organs and systems. che has been shown to have protective effects on the liver, heart, and blood vessels, which are commonly affected by kidney disease. By promoting the health of these organs, cistanche helps improve overall kidney function and prevent further complications.

In conclusion, cistanche is a traditional Chinese herbal medicine used for centuries to treat kidney disease. Its active components have diuretic, antioxidant, anti-inflammatory, immunomodulatory, and regenerative effects, which help improve renal function and protect the kidneys from further damage. , cistanche has beneficial effects on other organs and systems, making it a holistic approach to treating kidney disease.