05). Conclusions: Urinary angiotensinogen levels were remarkably high in the acute phase in the patients with proteinuric HSP, suggesting increased UAGT may indicate a series of functional changes in the kidney and it may be used as a potential biomarker of severity of HSP to monitor the progression of HSP with renal involvement. “
“Date written: December 2008 Final submission: October 2009 No recommendations possible based on Level
I or II evidence (Suggestions are based on Level PF-562271 III and IV evidence) Atherosclerotic renovascular stenosis is a potentially progressive disease. Not relevant to this subtopic. This guideline covers the following areas: ARVD For the purposes of this guideline and after accommodating for variability between studies (reviewed below), ARVD has been classified into this website the following grades based on the degree of stenosis: high (>70%) The following endpoints have been addressed when considering the natural history
of ARVD: Clinical: requirement of hypertensive medications Approximately 1–6% of hypertensive patients have renovascular lesions on arteriography.1–4 Unselected autopsy data suggest that 27% of patients over 50 years have more than 50% stenosis of at least one renal artery.5 It is the primary cause of renal failure in 5–22% of patients over 50 years who begin dialysis. Various risk factors have been identified in relation to the occurrence and progression of ARVD. Management of ARVD is made controversial by the lack of randomized controlled trials. Available studies differ widely in the variables that may influence renal survival such as hypertension control, interventions for revascularization (surgery, angioplasty alone, and angioplasty with stenting with and without distal protection devices) and medical therapy. Furthermore, Forskolin clinical trial the potential risks
of the intervention such as contrast nephropathy and cholesterol embolism may cause significant morbidity. Knowledge of the natural history and risk factors for progression of RAS can thus be helpful in deciding whether, when and how to intervene. A number of studies looking at the natural history of ARVD have demonstrated progression of RAS, including to renal artery occlusion. However, there is no Level I or II evidence to support any recommendations regarding the natural history. Prospective studies are scarce because of the multiple interventions that either confound the results or make such study designs impractical. Allocation of patients with very mild or very severe lesions to the conservative management arm may lead to selection bias. Knowledge of the natural progression of ARVD has been largely derived from studies that are retrospective, have used historical controls, or case series.