Reversal of Renal Failure after Revascularization in Atheromatous Renovascular Disease

Abstract

We report 2 patients with severe renal failure and hypertension secondary to atherosclerotic renovascular disease who required hemodialysis. Successful surgical revascularization in these patients resulted in the recovery of renal function (twice in a patient) and in controlling the blood pressure. These results indicate that in the presence of severe renal artery obstruction renal parenchyma may be preserved, while renal function is absent. We highlight the usefulness of preoperative renal arteriography for evaluation of the affected vessel and the demonstration of collateral circulation and the value of preoperative renal biopsy in the prediction of the viability of the kidney parenchyma.

Percutaneous revascularization of occluded renal arteries in the setting of acute renal failure

“…12 Prompt or even delayed revascularization may lead to complete or near complete recovery of renal function. 2,[4][5][6][7] It should be emphasized that after surgical or endovascular revascularization of ischemic nephropathy, up to 25% of patients experience improvement in renal function, 50% of patients have stabilization and up to 25% of patients note a deterioration of renal function. [13][14][15][16] Deterioration in renal function can be abrupt and progressive.…”

Reversal of acute renal failure by kidney revascularisation

“…Some preoperative markers are useful in predicting cases in which retrieval of renal function is achievable : kidney size of at least 9 cm length, 2,5-7,14,16-18 residual isotopic glomerular filtration, 7 disease-free distal renal artery 3,7,16,17 on late angiogram or evidenced by echo-Duplex, or renal biopsy. 2,3,5,13 Kidney size and a patent renal artery beyond the main stem occlusion are the most reliable predictors. Isotopic function tests lose much sensitivity in poorly perfused kidneys and intraoperative biopsy is questionable since it offers focal information and will be normal if other criteria are met.…”

“…The critical hypoperfusion at subfiltration pressure by way of capsular collaterals is sufficient to preserve viability of the glomeruli, even for prolonged periods, but is inadequate to ensure renal excretory function. 5,[8][9][10]22 This has been experimentally demonstrated by Morris et al 23 Perfusion pressures as low as 20 mmHg offer protection from parenchymatal anoxic injury but are suboptimal for urine production. The renal tubuli are more prone to ischaemic lesions, but also have a marked regenerative potential once normal kidney perfusion is restored.…”

“…Morris et al 4 was one of the first clinical investigators to obtain return of renal function by renovascular repair of totally occluded arteries supplying non-functioning kidneys. Many other short series or case reports [5][6][7][8][9][10][11][12][13][14] illustrate that even delayed revascularisation may re-establish renal function. We describe our experience with eight such cases.…”

How Important Is Atheromatous Renal Artery Stenosis as a Cause of End‐Stage Renal Disease?

“…By the end of the 1980s it was clear that ARAS could progress to renal artery occlusion, which usually resulted in failure and shrinkage of the kidney, often without symptoms of renal infarction. Occlusion of the artery to a solitary functioning kidney produced complete renal failure, but such kidneys could sometimes be salvaged by intervention (6, 7). One of the advocates of this procedure noted in 1989 that “patients with ESRD and ARAS without complete occlusion are not appropriate candidates for revascularization to restore renal function”(8).…”