Skip to main content
SpringerLink
Log in

Kurzfassung der S2k-Leitlinie Erkrankungen der Nierenarterie

Synopsis of the S2k guidelines on diseases of the renal artery

  • Gefäßmedizinische Evidenz
  • Published:
Gefässchirurgie Aims and scope Submit manuscript

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.

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Literatur

  1. Mantha M, Kumar SK, MacGinley R et al (2010) The CARI guidelines. Screening tests for diagnosis of renal artery stenosis. Nephrology 15:S218–26

    Article  Google Scholar 

  2. O’Neill WC, Bardelli M, Yevzlin AS (2011) Imaging for renovascular disease. Semin Nephrol 31:272–282

    Article  Google Scholar 

  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 32:2851–2906

    Article  Google Scholar 

  4. O’Reilly MJ, Hood JM, Livingston RH, Irwin JW (1979) Penetrating vascular injuries. J R Coll Surg Edinb 24:213–220

    PubMed  Google Scholar 

  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)

    Article  Google Scholar 

  6. Perazella MA (2009) Current status of gadolinium toxicity in patients with kidney disease. Clin J Am Soc Nephrol 4:461–469

    Article  CAS  Google Scholar 

  7. Hansen KJ, Tribble RW, Reavis SW et al (1990) Renal duplex sonography: evaluation of clinical utility. J Vasc Surg 12:227–236

    Article  CAS  Google Scholar 

  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 65:857–860

    Article  CAS  Google Scholar 

  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 13:271–276

    Article  Google Scholar 

  10. Karasch T, Strauss AL, Grün B et al (1993) Color-coded duplex ultrasonography in the diagnosis of renal artery stenosis. Dtsch Med Wochenschr 118:1429–1436

    Article  CAS  Google Scholar 

  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 122:833–838

    Article  CAS  Google Scholar 

  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 81:365–367

    Article  CAS  Google Scholar 

  13. Leung DA, Hoffmann U, Pfammatter T et al (1999) Magnetic resonance angiography versus duplex sonography for diagnosing renovascular disease. Hypertension 33:726–731

    Article  CAS  Google Scholar 

  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 214:739–746

    Article  CAS  Google Scholar 

  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 184:487–492

    Article  CAS  Google Scholar 

  16. Kliewer MA, Tupler RH, Carroll BA et al (1993) Renal artery stenosis: analysis of Doppler waveform parameters and tardus-parvus pattern. Radiology 189:779–787

    Article  CAS  Google Scholar 

  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 190:785–790

    Article  CAS  Google Scholar 

  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 162:412–419

    Article  CAS  Google Scholar 

  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 16:172–179

    Article  Google Scholar 

  20. Baxter GM, Aitchison F, Sheppard D et al (1996) Colour Doppler ultrasound in renal artery stenosis: intrarenal waveform analysis. Br J Radiol 69:810–815

    Article  CAS  Google Scholar 

  21. Riehl J, Schmitt H, Bongartz D, Bergmann D, Sieberth HG (1997) Renal artery stenosis: evaluation with colour duplex ultrasonography. Nephrol Dial Transplant 12:1608–1614

    Article  CAS  Google Scholar 

  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 40:54–63

    Article  Google Scholar 

  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 344:410–417

    Article  CAS  Google Scholar 

  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 58:510–515

    Article  Google Scholar 

  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 157:1226–1234

    Article  Google Scholar 

  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 17:1731–1736

    Article  Google Scholar 

  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–689S

    Article  CAS  Google Scholar 

  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 36:309–314

    CAS  PubMed  Google Scholar 

  29. Elliott WJ, Martin WB, Murphy MB (1993) Comparison of two noninvasive screening tests for renovascular hypertension. Arch Intern Med 153:755–764

    Article  CAS  Google Scholar 

  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 20:617–623

    Article  CAS  Google Scholar 

  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 170:183–187

    Article  CAS  Google Scholar 

  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

    Article  PubMed  Google Scholar 

  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, W150-1

    Article  Google Scholar 

  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 107:315–320

    Article  Google Scholar 

  35. Bavry AA, Kapadia SR, Bhatt DL, Kumbhani DJ (2014) Renal artery revascularization: updated meta-analysis with the CORAL trial. JAMA Intern Med 174:1849–1851

    Article  Google Scholar 

  36. Investigators A, Wheatley K, Ives N et al (2009) Revascularization versus medical therapy for renal-artery stenosis. N Engl J Med 361:1953–1962

    Article  Google Scholar 

  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 63:186–197

    Article  Google Scholar 

  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):497

    Article  Google Scholar 

  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

    Article  Google Scholar 

  40. Zanchetti A, Dominiczak A, Coca A et al (2018) 2018 ESC/ESH Guidelines for the management of arterial hypertension. Eur Heart J 39:3021–3104

    Article  Google Scholar 

  41. Hackam DG, Duong-Hua ML, Mamdani M et al (2008) Angiotensin inhibition in renovascular disease: a population-based cohort study. Am Heart J 156:549–555

    Article  CAS  Google Scholar 

  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 12:329–335

    Article  CAS  Google Scholar 

  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

    Article  PubMed  Google Scholar 

  44. Plouin P‑F (2003) Stable patients with atherosclerotic renal artery stenosis should be treated first with medical management. Am J Kidney Dis 42:851–857

    Article  Google Scholar 

  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 353:282–286

    Article  Google Scholar 

  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 46:447–454

    Article  Google Scholar 

  47. Kanjwal K, Haller S, Steffes M et al (2009) Complete versus partial distal embolic protection during renal artery stenting. Catheter Cardiovasc Interv 73:725–730

    Article  Google Scholar 

  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 25:511–520

    Article  Google Scholar 

  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)

    Article  Google Scholar 

  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)

    Article  CAS  Google Scholar 

  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 38:666–675

    Article  CAS  Google Scholar 

  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 60:242–276

    Article  Google Scholar 

Download references

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

Author information

Authors and Affiliations

  1. Klinik für Vaskuläre und Endovaskuläre Chirurgie, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1, Gebäude W30, 48149, Münster, Deutschland

    A. Oberhuber

  2. Klinik für Gefäßchirurgie, Gefäßmedizin und Transplantationschirurgie, Klinikum Stuttgart, Stuttgart, Deutschland

    T. Hupp

  3. Klinik für Diagnostische und Interventionelle Radiologie, Klinikum Stuttgart, Stuttgart, Deutschland

    G. M. Richter

  4. Nuklearmedizin und PET-Zentrum, Kantonsspital Aarau, Aarau, Schweiz

    E. U. Nitzsche

  5. Klinik für Nieren- und Hochdruckerkrankungen, Johannes Wesling Klinikum, Universitätsklinikum der Ruhr-Universität Bochum, Minden, Deutschland

    J. Radermacher

  6. Klinik für Nephrologie, Universitätsklinik der Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Deutschland

    L. C. Rump

  7. Nierenzentrum-Wiesbaden, Wiesbaden, Deutschland

    O. Vonend

Authors
  1. A. Oberhuber
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. T. Hupp
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. G. M. Richter
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. E. U. Nitzsche
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. J. Radermacher
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. L. C. Rump
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. O. Vonend
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to A. Oberhuber.

Ethics declarations

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.

Additional information

Die Vertreter der beteiligten Fachgesellschaften zur Erstellung der S2k-Leitlinie werden am Beitragsende genannt.

Anhang

Anhang

 

Tab. 2 Erklärungen über Interessenkonflikte: Tabellarische Zusammenfassung
Full size table

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Oberhuber, A., Hupp, T., Richter, G.M. et al. Kurzfassung der S2k-Leitlinie Erkrankungen der Nierenarterie. Gefässchirurgie 24, 251–257 (2019). https://doi.org/10.1007/s00772-019-0520-2

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00772-019-0520-2

Schlüsselwörter

Keywords

Search

Navigation