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Kurzfassung der S2k-Leitlinie Erkrankungen der Nierenarterie

  • A. OberhuberEmail author
  • T. Hupp
  • G. M. Richter
  • E. U. Nitzsche
  • J. Radermacher
  • L. C. Rump
  • O. Vonend
Gefäßmedizinische Evidenz
  • 21 Downloads

Zusammenfassung

Die Therapie der Nierenarterienstenose hat sich in den letzten 10 Jahren grundlegend gewandelt. Da die letzte Leitlinie aus dem Jahr 2008 datierte und nur ein S1-Niveau aufwies, war es an der Zeit, eine neue Leitlinie aufzulegen. Alle Fachgesellschaften, die an der Diagnostik, Therapie und Nachsorge von Nierenarterienstenosen (NAS) beteiligt sind, wurden von der Deutschen Gesellschaft für Gefäßchirurgie und Gefäßmedizin, Gesellschaft für operative, endovaskuläre und präventive Gefäßmedizin e. V. als federführende Fachgesellschaft eingeladen. Basierend auf einer Literaturrecherche über den Zeitraum von 2008 bis 2014 und später nochmal aktualisiert bis 2017 sowie der existierenden S1-Leitlinie wurde die Leitlinie erstellt. Die Konsensusfindung erfolgt durch ein Online-Delphi-Verfahren. Die Empfehlungen wurden überwiegend im „starken Konsens“ (Zustimmung von ≥95 % der Teilnehmer) oder im Konsens (Zustimmung von >75 % der Teilnehmer) getroffen.

Die Leitlinie behandelt neben der gesamten Diagnostik auch die Therapie, aber auch Empfehlungen zur Nachsorge von Patienten mit Nierenarterienstenosen, soweit Literaturdaten vorhanden sind.

Schlüsselwörter

Nierenarterienstenose Renovaskuläre Hypertonie Stent Angioplastie Nachsorge 

Synopsis of the S2k guidelines on diseases of the renal artery

Abstract

The treatment of renal artery stenosis has fundamentally changed in the last 10 years. As the last guidelines date back to 2008 and were only at the S1 level, it was time to produce new guidelines. All specialist societies that are involved in the diagnostics, treatment and aftercare of renal artery stenosis (RAS) were invited to participate by the German Society for Vascular Surgery and Vascular Medicine, Society for Operative, Endovascular and Preventive Vascular Medicine as the leading specialist society. The guidelines were compiled based on a literature search from 2008–2014 and later updated again to 2017 as well as on the existing S1 guidelines. Consensus decisions were achieved by means of an online Delphi procedure. The recommendations were predominantly made in strong consensus (approval by ≥95% of participants) or consensus (approval by ≥75% of participants). In addition to the complete diagnostics, the guidelines also deal with the treatment as well as recommendations for aftercare of patients with RAS, as far as data from the literature are available.

Keywords

Renal artery stenosis Renovascular hypertension Stent Angioplasty Aftercare 

Notes

Beteiligte Fachgesellschaften und deren Vertreter bei der Erstellung der S2k-Leitlinie

Deutsche Gesellschaft für Gefäßchirurgie und Gefäßmedizin, Gesellschaft für operative, endovaskuläre und präventive Gefäßmedizin e. V. (DGG) (federführend) – Vertreter: Prof. Dr. med. A. Oberhuber (Leitlinienkoordination, alexander.oberhuber@ukmuenster.de), Prof. Dr. med. T. Hupp; Deutsche Gesellschaft für Nephrologie DGfN – Vertreter: Prof. Dr. med. J. Radermacher; Deutsche Hochdruckliga DHL – Vertreter: Prof. Dr. med. O. Vonend, Prof. Dr. med. L.C. Rump; Deutsche Röntgengesellschaft – Gesellschaft für medizinische Radiologie e. V. (DRG) – Vertreter: Prof. Dr. med. G.M. Richter; Deutsche Gesellschaft für Nuklearmedizin e. V. – Vertreter: Prof. Dr. med. E.U. Nitzsche

Einhaltung ethischer Richtlinien

Interessenkonflikt

Siehe Tab. 2 im Anhang.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

Literatur

  1. 1.
    Mantha M, Kumar SK, MacGinley R et al (2010) The CARI guidelines. Screening tests for diagnosis of renal artery stenosis. Nephrology 15:S218–26CrossRefGoogle Scholar
  2. 2.
    O’Neill WC, Bardelli M, Yevzlin AS (2011) Imaging for renovascular disease. Semin Nephrol 31:272–282CrossRefGoogle Scholar
  3. 3.
    Organisation ES, Members ATF, Tendera M et al (2011) ESC Guidelines on the diagnosis and treatment of peripheral artery diseases: document covering atherosclerotic disease of extracranial carotid and vertebral, mesenteric, renal, upper and lower extremity arteries: the Task Force on the Diagnosis and Treatment of Peripheral Artery Diseases of the European Society of Cardiology (ESC). Eur Heart J 32:2851–2906CrossRefGoogle Scholar
  4. 4.
    O’Reilly MJ, Hood JM, Livingston RH, Irwin JW (1979) Penetrating vascular injuries. J R Coll Surg Edinb 24:213–220PubMedGoogle Scholar
  5. 5.
    Vasbinder GBC, Nelemans PJ, Kessels AGH et al (2004) Accuracy of computed tomographic angiography and magnetic resonance angiography for diagnosing renal artery stenosis. Ann Intern Med 141:674–682 (discussion 82)CrossRefGoogle Scholar
  6. 6.
    Perazella MA (2009) Current status of gadolinium toxicity in patients with kidney disease. Clin J Am Soc Nephrol 4:461–469CrossRefGoogle Scholar
  7. 7.
    Hansen KJ, Tribble RW, Reavis SW et al (1990) Renal duplex sonography: evaluation of clinical utility. J Vasc Surg 12:227–236CrossRefGoogle Scholar
  8. 8.
    Postma CT, van Aalen J, de Boo T, Rosenbusch G, Thien T (1992) Doppler ultrasound scanning in the detection of renal artery stenosis in hypertensive patients. Br J Radiol 65:857–860CrossRefGoogle Scholar
  9. 9.
    Schäberle W, Strauss A, Neuerburg-Heusler D, Roth FJ (1980) Value of duplex sonography in diagnosis of renal artery stenosis and its value in follow-up after angioplasty (PTA). Ultraschall Med 13:271–276CrossRefGoogle Scholar
  10. 10.
    Karasch T, Strauss AL, Grün B et al (1993) Color-coded duplex ultrasonography in the diagnosis of renal artery stenosis. Dtsch Med Wochenschr 118:1429–1436CrossRefGoogle Scholar
  11. 11.
    Olin JW, Piedmonte MR, Young JR, DeAnna S, Grubb M, Childs MB (1995) The utility of duplex ultrasound scanning of the renal arteries for diagnosing significant renal artery stenosis. Ann Intern Med 122:833–838CrossRefGoogle Scholar
  12. 12.
    Vigna C, Pacilli MA, Testa M et al (1998) Comparison of steerable continuous-wave versus pulsed-wave Doppler ultrasonography to renal artery angiography in diagnosing renal artery stenosis. Am J Cardiol 81:365–367CrossRefGoogle Scholar
  13. 13.
    Leung DA, Hoffmann U, Pfammatter T et al (1999) Magnetic resonance angiography versus duplex sonography for diagnosing renovascular disease. Hypertension 33:726–731CrossRefGoogle Scholar
  14. 14.
    Claudon M, Plouin PF, Baxter GM, Rohban T, Devos DM (2000) Renal arteries in patients at risk of renal arterial stenosis: multicenter evaluation of the echo-enhancer SH U 508A at color and spectral doppler US. Levovist renal artery Stenosis study group. Radiology 214:739–746CrossRefGoogle Scholar
  15. 15.
    Stavros AT, Parker SH, Yakes WF et al (1992) Segmental stenosis of the renal artery: pattern recognition of tardus and parvus abnormalities with duplex sonography. Radiology 184:487–492CrossRefGoogle Scholar
  16. 16.
    Kliewer MA, Tupler RH, Carroll BA et al (1993) Renal artery stenosis: analysis of Doppler waveform parameters and tardus-parvus pattern. Radiology 189:779–787CrossRefGoogle Scholar
  17. 17.
    Schwerk WB, Restrepo IK, Stellwaag M, Klose KJ, Schade-Brittinger C (1994) Renal artery stenosis: grading with image-directed Doppler US evaluation of renal resistive index. Radiology 190:785–790CrossRefGoogle Scholar
  18. 18.
    Speckamp F, Vorwerk D, Schürmann K et al (1995) Color-coded duplex ultrasonography in the diagnosis of renal artery stenosis. Fortschr Geb Rontgenstrahlen Nuklearmed 162:412–419CrossRefGoogle Scholar
  19. 19.
    Strank H, Jaeger U, Teifke A (1980) Intrarenal color Doppler ultrasound for exclusion of renal artery stenosis in cases of multiple renal arteries. Analysis of the Doppler spectrum and tardus parvus phenomenon. Ultraschall Med 16:172–179CrossRefGoogle Scholar
  20. 20.
    Baxter GM, Aitchison F, Sheppard D et al (1996) Colour Doppler ultrasound in renal artery stenosis: intrarenal waveform analysis. Br J Radiol 69:810–815CrossRefGoogle Scholar
  21. 21.
    Riehl J, Schmitt H, Bongartz D, Bergmann D, Sieberth HG (1997) Renal artery stenosis: evaluation with colour duplex ultrasonography. Nephrol Dial Transplant 12:1608–1614CrossRefGoogle Scholar
  22. 22.
    Ripollés T, Aliaga R, Morote V et al (2001) Utility of intrarenal Doppler ultrasound in the diagnosis of renal artery stenosis. Eur J Radiol 40:54–63CrossRefGoogle Scholar
  23. 23.
    Radermacher J, Chavan A, Bleck J et al (2001) Use of Doppler ultrasonography to predict the outcome of therapy for renal-artery stenosis. N Engl J Med 344:410–417CrossRefGoogle Scholar
  24. 24.
    Zeller T, Müller C, Frank U et al (2003) Stent angioplasty of severe atherosclerotic ostial renal artery stenosis in patients with diabetes mellitus and nephrosclerosis. Catheter Cardiovasc Interv 58:510–515CrossRefGoogle Scholar
  25. 25.
    van Jaarsveld BC, Krijnen P, Derkx FH, Oei HY, Postma CT, Schalekamp MA (1997) The place of renal scintigraphy in the diagnosis of renal artery stenosis. Fifteen years of clinical experience. Arch Intern Med 157:1226–1234CrossRefGoogle Scholar
  26. 26.
    van Jaarsveld BC, Pieterman H, van Dijk LC et al (1999) Inter-observer variability in the angiographic assessment of renal artery stenosis. DRASTIC study group. Dutch Renal Artery Stenosis Intervention Cooperative. J Hypertens 17:1731–1736CrossRefGoogle Scholar
  27. 27.
    Geyskes GG, de Bruyn AJ (1991) Captopril renography and the effect of percutaneous transluminal angioplasty on blood pressure in 94 patients with renal artery stenosis. Am J Hypertens 4:685S–689SCrossRefGoogle Scholar
  28. 28.
    Dondi M, Fanti S, Barozzi L et al (1992) Evaluation by captopril renal scintigraphy and echo-Doppler flowmetry of hypertensive patients at high risk for renal artery stenosis. J Nucl Biol Med 36:309–314PubMedGoogle Scholar
  29. 29.
    Elliott WJ, Martin WB, Murphy MB (1993) Comparison of two noninvasive screening tests for renovascular hypertension. Arch Intern Med 153:755–764CrossRefGoogle Scholar
  30. 30.
    Fommei E, Ghione S, Hilson AJ et al (1993) Captopril radionuclide test in renovascular hypertension: a European multicentre study. European Multicentre Study Group. Eur J Nucl Med 20:617–623CrossRefGoogle Scholar
  31. 31.
    Harward TR, Poindexter B, Huber TS, Carlton LM, Flynn TC, Seeger JM (1995) Selection of patients for renal artery repair using captopril testing. Am J Surg 170:183–187CrossRefGoogle Scholar
  32. 32.
    Jenks S, Yeoh SE, Conway BR (2014) Balloon angioplasty, with and without stenting, versus medical therapy for hypertensive patients with renal artery stenosis. Cochrane Database Syst Rev.  https://doi.org/10.1002/14651858.CD002944.pub2 CrossRefPubMedGoogle Scholar
  33. 33.
    Bax L, Woittiez A‑JJ, Kouwenberg HJ et al (2009) Stent placement in patients with atherosclerotic renal artery stenosis and impaired renal function: a randomized trial. Ann Intern Med 150:840–8, W150-1CrossRefGoogle Scholar
  34. 34.
    Booher AM, Isselbacher EM, Nienaber CA et al (2011) Ascending thoracic aorta dimension and outcomes in acute type B dissection (from the international registry of acute aortic dissection [IRAD]). Am J Cardiol 107:315–320CrossRefGoogle Scholar
  35. 35.
    Bavry AA, Kapadia SR, Bhatt DL, Kumbhani DJ (2014) Renal artery revascularization: updated meta-analysis with the CORAL trial. JAMA Intern Med 174:1849–1851CrossRefGoogle Scholar
  36. 36.
    Investigators A, Wheatley K, Ives N et al (2009) Revascularization versus medical therapy for renal-artery stenosis. N Engl J Med 361:1953–1962CrossRefGoogle Scholar
  37. 37.
    Ritchie J, Green D, Chrysochou C, Chalmers N, Foley RN, Kalra PA (2014) High-risk clinical presentations in atherosclerotic renovascular disease: prognosis and response to renal artery revascularization. Am J Kidney Dis 63:186–197CrossRefGoogle Scholar
  38. 38.
    Vassallo D, Ritchie J, Green D, Chrysochou C, Kalra PA (2017) The effect of revascularization in patients with anatomically significant atherosclerotic renovascular disease presenting with high-risk clinical features. Nephrol Dial Transplant 33(3):497CrossRefGoogle Scholar
  39. 39.
    Mancia G, Fagard R, Narkiewicz K, Redon J, Zanchetti A, Böhm M et al (2014) 2013 ESH/ESC practice guidelines for the management of arterial hypertension. Blood Pressure:23(1):3–16.  https://doi.org/10.3109/08037051.2014.868629 CrossRefGoogle Scholar
  40. 40.
    Zanchetti A, Dominiczak A, Coca A et al (2018) 2018 ESC/ESH Guidelines for the management of arterial hypertension. Eur Heart J 39:3021–3104CrossRefGoogle Scholar
  41. 41.
    Hackam DG, Duong-Hua ML, Mamdani M et al (2008) Angiotensin inhibition in renovascular disease: a population-based cohort study. Am Heart J 156:549–555CrossRefGoogle Scholar
  42. 42.
    Webster J, Marshall F, Abdalla M et al (1998) Randomised comparison of percutaneous angioplasty vs continued medical therapy for hypertensive patients with atheromatous renal artery stenosis. Scottish and Newcastle Renal Artery Stenosis Collaborative Group. J Hum Hypertens 12:329–335CrossRefGoogle Scholar
  43. 43.
    Nordmann AJ, Logan AG (2003) Balloon angioplasty versus medical therapy for hypertensive patients with renal artery obstruction. Cochrane Database Syst Rev.  https://doi.org/10.1002/14651858.CD002944 CrossRefPubMedGoogle Scholar
  44. 44.
    Plouin P‑F (2003) Stable patients with atherosclerotic renal artery stenosis should be treated first with medical management. Am J Kidney Dis 42:851–857CrossRefGoogle Scholar
  45. 45.
    van de Ven PJ, Kaatee R, Beutler JJ et al (1999) Arterial stenting and balloon angioplasty in ostial atherosclerotic renovascular disease: a randomised trial. Lancet 353:282–286CrossRefGoogle Scholar
  46. 46.
    Khosla A, Misra S, Greene EL et al (2012) Clinical outcomes in patients with renal artery stenosis treated with stent placement with embolic protection compared with those treated with stent alone. Vasc Endovascular Surg 46:447–454CrossRefGoogle Scholar
  47. 47.
    Kanjwal K, Haller S, Steffes M et al (2009) Complete versus partial distal embolic protection during renal artery stenting. Catheter Cardiovasc Interv 73:725–730CrossRefGoogle Scholar
  48. 48.
    Murphy TP, Cooper CJ, Cutlip DE et al (2014) Roll-in experience from the Cardiovascular Outcomes with Renal Atherosclerotic Lesions (CORAL) study. J Vasc Interv Radiol 25:511–520CrossRefGoogle Scholar
  49. 49.
    Balzer KM, Pfeiffer T, Rossbach S et al (2009) Prospective randomized trial of operative vs interventional treatment for renal artery ostial occlusive disease (RAOOD). J Vasc Surg 49:667–674 (discussion 74–5)CrossRefGoogle Scholar
  50. 50.
    Cambria RP, Brewster DC, L’Italien GJ et al (1996) Renal artery reconstruction for the preservation of renal function. J Vasc Surg 24:371–380 (discussion 80–2)CrossRefGoogle Scholar
  51. 51.
    Abela R, Ivanova S, Lidder S, Morris R, Hamilton G (2009) An analysis comparing open surgical and endovascular treatment of atherosclerotic renal artery stenosis. Eur J Vasc Endovasc Surg 38:666–675CrossRefGoogle Scholar
  52. 52.
    American College of Cardiology Foundation (ACCF), American College of Radiology (ACR), American Institute of Ultrasound in Medicine (AIUM), American Society of Echocardiography (ASE), American Society of Nephrology (ASN), Intersocietal Commission for the Accreditation of Vascular Laboratories (ICAVL), et al. ACCF/ACR/AIUM/ASE/ASN/ICAVL/SCAI/SCCT/SIR/SVM/SVS/SVU [corrected] (2012) Appropriate use criteria for peripheral vascular ultrasound and physiological testing part I: Arterial ultrasound and physiological testing: A report of the American College of Cardiology Foundation appropriate use criteria task force, American College of Radiology, American Institute of Ultrasound in Medicine, American Society of Echocardiography, American Society of Nephrology, Intersocietal Commission for the Accreditation of Vascular Laboratories, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Computed Tomography, Society for Interventional Radiology, Society for Vascular Medicine, Society for Vascular Surgery, [corrected] and Society for Vascular Ultrasound. [corrected]. J Am Coll Cardiol 60:242–276CrossRefGoogle Scholar

Copyright information

© Springer Medizin Verlag GmbH, ein Teil von Springer Nature 2019

Authors and Affiliations

  • A. Oberhuber
    • 1
    Email author
  • T. Hupp
    • 2
  • G. M. Richter
    • 3
  • E. U. Nitzsche
    • 4
  • J. Radermacher
    • 5
  • L. C. Rump
    • 6
  • O. Vonend
    • 7
  1. 1.Klinik für Vaskuläre und Endovaskuläre ChirurgieUniversitätsklinikum MünsterMünsterDeutschland
  2. 2.Klinik für Gefäßchirurgie, Gefäßmedizin und TransplantationschirurgieKlinikum StuttgartStuttgartDeutschland
  3. 3.Klinik für Diagnostische und Interventionelle RadiologieKlinikum StuttgartStuttgartDeutschland
  4. 4.Nuklearmedizin und PET-ZentrumKantonsspital AarauAarauSchweiz
  5. 5.Klinik für Nieren- und Hochdruckerkrankungen, Johannes Wesling KlinikumUniversitätsklinikum der Ruhr-Universität BochumMindenDeutschland
  6. 6.Klinik für NephrologieUniversitätsklinik der Heinrich-Heine-Universität DüsseldorfDüsseldorfDeutschland
  7. 7.Nierenzentrum-WiesbadenWiesbadenDeutschland

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