Thursday, February 9, 2012

CLINICAL CASE 51, Answers and Summary


TRUE OR FALSE: RENAL ARTERY STENOSIS ON THE AFFECTED SIDE PROTECTS ON DEVELOPMENT OF GLOMERULAR DISEASE ON THAT SIDE.

True
  16 (39%)
 
False
  13 (31%)
 
Hmmm....depends on the glomerular disease
  12 (29%

Based on some of the review of the literature and recent nephrol group comments, renal artery stenosis protects against glomerulonephritis.
In experimental models of serum sickness where immune complexes are formed, the side that had stenosis or obstruction was spared of the immune complex deposots.  Hence, decreased perfusion/filtration decreased chances of immune complex depositon. Multiple case series have supported this hypothesis.  A case report in 1997 also showed that FSGS was spared in the kidney that was having stenosis. The first case of such a protection was described as early as 1960s. Look below for full references. To my knowledge, I couldn't find any specific glomerular disease that made a different observation than most stated below.  Although, the side that has stenosis might see ischemic nephropathy, but there is sparing of the glomerular disease process. This might be also true for diabetic nephropathy cases.

A discussion about this might be needed as not much out there on this specific question. Feel free to comment.

Ref:

1 comment:

  1. Could ischemia in the stenosed kidney induce glomerulo-protective mechanisms at the genetic level ? Eg a form of ischemic preconditioning, and if yes could those genetic targete be activated by targeted therapy to induce protection against a whole host of renal GN and TI disorders ?

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