Author/Editor		Buturović-Ponikvar, Jadranka
Title		Zožitev arterije presajene ledvice
Translated title		Renal transplant artery stenosis
Type		članek
Source		Med Razgl
Vol. and No.		Letnik 42, št. Suppl 2
Publication year		2003
Volume		str. 113-7
Language		slo
Abstract		Renal transplant artery stenosis is a relatively frequent complication of transplantation, with an incidence of up to 23%. Renal arteriography still remains the gold standard for its diagnosis. Several imaging techniques are available for screening (duplex-Doppler, nuclear magnetic resonance, spiral computerized tomography) and their use partially depends on the center's experience. Treatment can be conservative (provided that graft perfusion is not jeopardized) or by revascularization (surgical or percutaneous transluminal angioplasty). There are several unresolved questions concerning revascularization of stenosis: Whether and when to intervene? Is stenosis progressive over the long term? Is hypertension alone an indication for angioplasty? How to assess the hemodynamic significance of stenosis? What is significant stenosis - 50%, 60%, 80% or 90%? Is stenosis perhaps also good for anything? In Slovenia, all renal transplant recipients have been regularly screened since 1990 for the presence of stenosis using duplex-Doppler (which is performed by nephrologists), and duplex-Doppler is also performed in the case of graft function deterioration or hypertension. In the majority of patients, stenosis was found to be stable over time (as assessed by regular Doppler, graft function and hypertension controls). Spontaneous regression of stenosis was also observed in some patients. Frequent Doppler assessment of these patients helps us to be more conservative regarding angioplasty and angiography. Deterioration of the graft's functioning (with stenosis diagnosed by Doppler) is the main indication for angiography (and angioplasty). A better definition of significant stenosis and randomized studies comparing conservative treatment vs. angioplasty are warranted. Duplex-Doppler seems to be the ideal screening and follow-up test.
Summary		Zožitev ledvične arterije presajene ledvice je dokaj pogost zaplet po presaditvi. Poročajo o pojavnosti pri do 23% bolnikov s presajeno ledvico. Zlati standard za diagnozo je še vedno ledvična angiografija. Doplersko preiskavo z dvojnim prikazom, magnetno resonančno angiografijo ali spiralno računalniško tomografijo uporabljamo kot presejalne teste, kar je med drugim tudi odvisno od lokalne opreme in izkušenj. Zožitev ledvične arterije presajene ledvice zdravimo lahko konzervativno (pod pogojem, da ni ogrožena prekrvljenost presajene ledvice) ali z revaskularizacijo (kirurško ali s perkutano angioplastiko). Glede revaskularizacije zožitve je še vedno precej dilem: kdaj in ali sploh naj interveniramo? Kakšen je naravni potek zoženja? Ali je hipertenzija (z dobro ledvično funkcijo) indikacija za revaskularizacijo? Kako naj ocenimo hemodinamsko pomembnost zožitve? Kaj je pomembna zožitev - 50, 60, 80 ali 90%? Ali je določena stopnja zožitve lahko "ugodna"? V Sloveniji vse bolnike s presajeno ledvico doplersko pregledujemo od leta 1990, redno in v primerih poslabšanja hipertenzije ali ledvične funkcije. Doplersko preiskavo izvajamo nefrologi. Ugotovili smo, da je pri večini bolnikov zožitev dolgoročno stabilna (glede na funkcijo presadka in hipertenzijo). Opazili smo tudi spontano regresijo zožitve pri nekaterih bolnikih. Pogoste doplerske preiskave so nam omogočile večjo konzervativnost glede angioplastike in angiografije. Glavna indikacija za angiografijo (in angioplastiko) je poslabšanje funkcije presadka, ob doplersko že dokazani zožitvi. V prihodnosti potrebujemo boljšo definicijo pomembne zožitve in randomizirane študije, ki bi primerjale konzervativno zdravljenje z revaskularizacijo. Doplerska preiskava z dvojnim prikazom je idealna za kot presejalni test in za sledenje že dokazane zožitve.
Descriptors		RENAL ARTERY OBSTRUCTION KIDNEY TRANSPLANTATION RENAL ARTERY ANGIOPLASTY, BALLOON