**4. Acknowledgement**

We thank Dr. Yu-Guang Chen, Tri-Service General Hospital for his kindly providing the image of MDCT angiography.

#### **5. References**

156 Chronic Kidney Disease

Accordingly, only 20-25% of patients may be eligible for elective renal revascularization. There have some image, histology and clinical evidence to select patients with ARVD having benefits to undergo renal artery revascularization which is described as follow

1. Visualization of the collecting system either on an intravenous pyelogram or during the

3. The presence of intact glomeruli on frozen section biopsy at the time of surgery.

Revascularization Indications Comments

Ostial and non-ostial lesions


Table 6. Comparison of three types of revascularization intervention. PTA: percutaneous transluminal angioplasty; TVR: target vessel revascularization; ASTRAL: Angioplasty and

ARVD reflecting a status of systemic atherosclerosis is associated with chronic renal disease. Life style modification and risk factors reduction are important for the primary prevention of ongoing renal dysfunction and secondary prevention of subsequent cardiovascular events. Some clinical features of patients at risk for ARVD should be highlighted and both medical treatment and mechanical procedures should be taken as early as possible if uncontrolled hypertension leading to end-organ damage or progressive renal insufficiency

Stenting for Renal Artery Lesions; ACC/AHA: American College of Cardiology






rate than PTA alone

functions

years period

10%

4. Rapid decline of renal functions after ACEI/ARB administrations.

There are three methods for renal artery revascularization (table 6).

(Connolly et al, 1994) Non-ostial lesions

(Novick et al, 1987; Muray et al, 2002).

2. Kidney length ≥9 cm.

PTA without stenting

PTA with stenting (ASTRAL investigators, 2009; Stone et al, 2011; White, 2010; Davies et al, 2009)

Bypass surgery (ACC/AHA 2005 guidelines; Hansen et al, 1992)

**3. Conclusion** 

develops.

Foundation/American Heart Association.

pyelogram phase after renal arteriography


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**10**

*USA* 

**Pharmacologic Adjuvants to Reduce** 

*Lankenau Medical Center and Lankenau Institute for Medical Research* 

Anemia is one of the leading causes of morbidity in chronic renal failure.**1** Chronic kidney disease (CKD) associated anemia is largely due to reduced erythropoietin (EPO) release and, to a lesser degree, to shortened red cell survival.**2** To overcome EPO deficiency in this population, the development and administration of erythropoiesis-stimulating agents (ESAs) such as recombinant human EPO and darbepoetin alfa (DPO) has resulted in substantial health benefits, including improved quality of life, reduced blood transfusion requirements, decreased left ventricular mass, diminished sleep disturbance and enhanced exercise capacity.**1-7** Unfortunately in recent clinical trials, a proportion of patients exhibited complications such as fatal or nonfatal stroke, access thrombosis, increase in thrombotic events and exacerbation of malignancy associated with overly aggressive correction of anemia. **8-10** It is not established whether these complications are related to higher dose of EPO, underlying EPO resistance factors (i.e. inflammation) or achieving higher hematocrit (HCT). A multifactorial combination of predisposing circumstances is possible. A number of pharmacologic agents have been evaluated as adjuvant to ESAs therapy. These agents include iron, L-carnitine, ascorbic acid, androgens, statins, pentoxifylline and Nacetylcysteine. In this review article we will focus on the agents that have been used in conjunction with EPO to correct anemia in patient with chronic kidney disease and end-

Iron is one of the most integral components of hematopoiesis in the anemia of kidney disease. "Trapped" iron storage or decreased availability of iron is the most common factor for the resistance to the effect of ESAs. Absolute iron deficiency is likely to be present in patients with CKD when**:** the percent transferrin saturation (plasma iron divided by total iron binding capacity x 100) falls below 20; the serum ferritin concentration is less than 100 ng/mL among advance CKD("predialysis") and peritoneal dialysis patients and less than

stage renal disease in an effort to reduce the dose requirement of EPO.

**1. Introduction** 

**2. Iron** 

**Chronic Kidney Disease and**

Adeel Siddiqui, Aqeel Siddiqui and Robert Benz

**End Stage Renal Disease** 

*Wynnewood, Pennsylvania* 

**Erythropoietin Therapy Dose in Anemia of** 

