Atherosclerotic Renal Artery Stenosis Of Long-term Observation Of Kidney Treatment Of Slow Decline

Ischemic renal disease (IRD) refers to obvious changes in renal hemodynamics,cau sed by unilateral or bilateral renal artery stenosis or occlusion.It causes the decline in glomerular filtration rate (GFR) and chronic kidney disease.Renal artery stenosis is ca used by a heterogeneous group of conditions, including atherosclerosis, fibromuscular d ysplasia (FMD),vasculitis.The first two are the most common.Atheromatous renal artery stenosis(ARAS) happens in people over40,with a history of smoking,dyslipidemia an d diabetes.In this group of people,90%IRD is caused by ARAS.FDM mainly develops in femal younger than40.With the rising of obesity,an aging population,diabetes and hypertension,the incidence of ARAS has been rising.ARAS is becoming a serious threa ten to human health.Meanwhile,ARAS comes along with coronary atherosclerotic heart disease and other vascular diseases frequently.ARAS may ultimately leads to the end point of clinical cardiovascular events. It is reported in foreign countries that16.5%p atients suffering from dialysis are caused by ARAS leading to ESRD. According to a reports,the annual mortality of ARAS is16%.There is no unified conclusion for the tr eatment of ARAS. Interventional therapy and drug therapy both own flaws. In recent years,TCM has been doing a lot of research of ARAS. We have preliminarily explore d the pathogenesis and differential diafnosis of ARAS and achieved significant clinical efficacy. We did a retrospective study with the ARAS patients,in order to observe the long-term curative effect of ARAS by Huanshuai Recipe oral solution treatment.Objective:To observe the long-term curative effect of ARAS by Huanshuai Reci pe oral solution treatment. It is designed to prove the importance and effectiveness of the TCM intervention to ARAS.Methods:1.Case source:patients diagnosed with ARA S.2.Clinical statistics:collect retrospective case and make a control study, with a total of34cases.3.Clinical data collection:the happening of primary and secondary end poin t event,check the renal function(SCR,BUN,UA),blood lipids(CHO,TG,LDL),blood pressu re levels(SBP,DBP),end point/replacement end point,survival status,and make a comparis on from renal function,blood lipids,blood pressure and survival rate between the two g roups.4.Statistical analysis:application the SPSS17.0establish database and analyzed,whe n p<0.05difference was considered to have statistical meaning.Results:1.A total of34cases of patients with ARAS were included in the statistics:19in treatment group and15in control group.The observation period is6-74months,with average observation period36.50±15.01months.Male20,female14.Age41-87,with avera ge age71.53±12.25. The The staging situation of CKD in group patients:the control group:CKD1:1(6.67%),CKD2:5(33.33%),CKD3:7(46.67%),CKD4:2(13.33%);t he treatment group:CKD1:0(0%),CKD2:2(10.53%),CKD3:14(73.68%),CKD4:3(15.79%).The most common comorbidities of ARAS patients is Hypertension(100%),foll owed by the Hyperlipidemia (64.71%),Coronary artery disease (47.06%),Diabetes (29.41%),Cerebral vascular disease (26.07%) and hyperuricemia (14.71%).2.Primary end point:6people in control group were died bacause of sever cardio vascular events,none in treatment group.Secondary end point:(1)one in control group d oubled Scr,none in treatment group.(2)12in control group was hospitalized,and9in tr eatment group,*p<0.05.The average time of hospitalization in control group is1.73±1.49,and treatment group0.63±0.83,*p<0.05.3.Renal damage progress:(1) Scr:control group:before treatment:126.07±50.50u mol/l,after treatment:147.67±61.95umol/1.The sample-paired T test within group of the mean of SCR values,before and after treatment,from the control group patients,*p<0.05,was statistically significant.Treatment group:before treatment:136.11±31.49umol/1,aft er treatment:128.96±68.44umol/l.The sample-paired T test within group of the mean o f SCR values,before and after treatment,from the treatment group patients,*p<0.05,was statistically significant.(2)eGFR:control group:before treatment:55.16±20.52ml/min·l.722, after treatment44.51±19.11ml/min·1.722,*p<0.05,annual gradient:-0.77±1.92ml/mi n-1.732/y. Treatment group:before treatment:46.49±13.50ml/min·1.732, after treatment52.47±18.26ml/min·1.732,*p<0.05, annual gradient:0.17±0.38ml/min·1.732/y. Independe nt sample T test with eGFR annual gradient:*p<0.05.4.Blood pressure:control group:before treatment:SBP129.13±8.10mmHg,DBP73.93±4.23mmHg, after treatment:SBP132±6.22mmHg,DBP79.60±6.60mmHg, The sampl e-paired T test within group of SBP,*p<0.05. Treatment group:before treatment:SBP125.84±8.68mmHg,DBP74.74±9.49mmHg, after treatment:SBP125.89±6.72mmHg,DB P69.79±10.25mmHg. The sample-paired T test within group of DBP,*p<0.05.5. Lipid levels:control group:before treatment:CHO4.45±1.10mmol/1,TG2.57±1.18mmo1/1,LDL1.69±0.49mmol/1, after treatment:CHO4.77±0.89mmo1/1,TG2.06±1.23m mol/1,LDL2.95±0.62mmo1/1.Treatment group:before treatment:CHO4.99±8.21mmol/l,T G3.32±0.88mmol/1,LDL2.08±0.86mmol/1, after treatment:CHO4.49±1.26mmol/1,TG1.95±0.89mmol/1,LDL2.59±0.86mmol/1. The sample-paired T test within treatment group of TG,*p<0.05. Conclusion:Huanshuai Recipe oral solution treatment reduces the incidence of end point event s,and the risk of hospitalization,prolong the survival period.The function of kidney in ARAS can be stabilized or even improved by T Huanshuai Recipe oral solution treat ment.And it helps to extend ARAS patients’survival time.In addition, the ARAS patie nts’ blood pressure, blood lipid level can be efficiently controlled.