Reversal of Renal Failure by Revascularisation of Kidneys With Thrombosed Renal Arteries

Sheil, A. G. R.; Stokes, Gordon S.; Tiller, David J.; May, James R.; Johnson, J. R.; Stewart, John H.

doi:10.1016/s0140-6736(73)92002-3

Cited by 41 publications

(12 citation statements)

References 7 publications

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“…16, 18, 26. 27], In 8 cases, reconstructive surgery was performed 5-39 days after the onset of oliguric renal failure [7,14,22,25], In this respect, our case is unique since reestablishment of renal function was achieved a full 47 days after renal arterial occlusion. Although technical difficulties precluded the angiographic demonstration of collaterals in our case, numerous factors indirectly support the existence of a well-developed collateral circulation.…”

Section: Discussionmentioning

confidence: 92%

“…In addition to arterial occlusion, angiography frequently shows a delayed nephrogram through the collateral ves sels. The diagnosis is confirmed at operation by the dem onstration of a viable-appearing kidney with measurable hydrostatic pressure in the renal artery distal to the occlu sion, and retrograde flow when the renal artery is severed [11,14,16,22,[25][26][27], As an alternative to the surgical approach, the occlusive material in the renal artery may be removed by Fogarty catheter [18].…”

Section: Discussionmentioning

confidence: 99%

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Renal Functional Recovery 47 Days after Renal Artery Occlusion

Ramsay¹,

D’Agati²,

Dietz³

et al. 1983

Am J Nephrol

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A patient with a single kidney and oliguric renal failure for 47 days experienced dramatic restoration of glomerular filtration and renal function following graft bypass of an occluded renal artery. There was very little evidence of acute tubular necrosis. The case emphasizes the importance of the renal collateral circulation in the maintenance of tissue viability, even when the hydrostatic pressure of collateral flow is inadequate for glomerular ultrafiltrate formation. The differentiation of oliguric renal failure due to renal arterial occlusion from that due to acute tubular necrosis following arterial injection of radiocontrast material is imperative because of the dramatic response to reconstructive vascular surgery.

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Section: Discussionmentioning

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Renal Functional Recovery 47 Days after Renal Artery Occlusion

Ramsay¹,

D’Agati²,

Dietz³

et al. 1983

Am J Nephrol

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“…Patients with bilateral renal artery stenosis may present in acute renal failure. 22 In attempting to analyze prognosis with therapy, it is helpful to consider patient mortality, control of blood pressure, and effects on renal function. In a 1968 study of 69 unoperated, medically treated patients followed for 1 to 6 years, mortality was 40%.…”

Section: Natural History and Prognosis With Therapymentioning

confidence: 99%

“…26 In the case of patients with renal artery stenosis on one or both sides, and with end-stage renal failure, there have been reports of dramatic improvement after revascularization of occluded arteries. 22 There is limited information on the long-term follow-up of patients in whom renal artery stenosis has been corrected by percutaneous transluminal renal angioplasty. 27 The morbidity and mortality of this procedure are less than that of surgical therapy.…”

Section: Natural History and Prognosis With Therapymentioning

confidence: 99%

Accelerated hypertension in a 64-year-old white woman.

Stokes¹

1984

Hypertension

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A 64-year-old white woman was referred to the Hypertension Unit of the Massachusetts General Hospital for evaluation and management of resistant hypertension. Past history revealed that she had had mild hypertension for 20 years, adult onset diabetes for 2 years, a myocardial infarction 7 years earlier, congestive heart failure, and angina. Her main complaint at the time of her initial evaluation was dyspnea, which mainly occurred with exertion. Indeed, she could only walk one block before having to stop because of dyspnea. She denied symptoms suggestive of intermittent claudication or cerebrovascular disease, and her angina was stable and mild. Her height was 4 ft 9 in., and she weighed 200 pounds.The patient's blood pressure was 196/118 mm Hg standing and 176/122 mm Hg lying, as recorded with an appropriately large cuff. The pulse was 88 bpm and regular. There was no delay of the femoral pulses and no abdominal or arterial bruits. The apex beat was displaced 2 cm to the left of the midclavicular line, and a palpable S4 was evident. Auscultation of the precordium confirmed the presence of a fourth heart sound, Address for reprints: Dr. Gordon S. Stokes, Royal North Shore Hospital, St. Leonards, N.S.W. 2965, Australia. but no S3 or murmur was present. Fundoscopy revealed Keith and Wagener (KW) Grade III changes with hemorrhages and marked arteriolar narrowing, but no exudates. The optic discs were sharp, and venous pulsations were evident. Neurological examination was normal. Medications included digoxin 0.25 mg four times daily, isosorbide dinitrate (Isordil) 40 mg four times daily, propranolol (Inderal) 40 mg four times daily, prazosin 6 mg times daily, trinitroglycerin one tablet as needed, hydrochlorothiazide 25 mg/ triamterene 50 mg (Dyazide) two tablets four times daily, and isophane (NPH) insulin, 58 U subcutaneously once per day.The patient was immediately hospitalized, and nifedinine 10 mg four times daily was added to the regimen. Shortly thereafter, she developed overt cardiac failure associated with a drop in blood pressure to 100/90 mm Hg. She responded to conventional therapy and temporary discontinuation of the antihypertensive medications.Relevant investigations performed over the next week were as follows. An electrocardiogram showed normal sinus rhythm, with changes consistent with an old anterolateral apical myocardial infarction, and ST segment elevation in leads V2-V5 that suggested an anteroapical aneurysm. Renal function, complete blood count, and biochemical profile were essentially normal. Serial cardiac enzyme determinations were normal. The blood sugar level was 283 mg/dl. A gated blood pool scan revealed a markedly hypertrophied left ventricle, a large apical aneurysm that emptied almost completely during systole and an ejection fraction of 54%. Doppler studies of the carotid arteries were normal. Pulmonary function studies showed changes consistent with poorly reversible chronic obstructive pulmonary disease. A thallium scan with persantin provocation was negative for myocardial isch...

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“…Improvement in renal function and blood pressure control have been achieved in these patients after a successful surgical or angioplastie revasculariza tion [5][6][7][8][9][10][11][12],…”

Section: Introductionmentioning

confidence: 99%

Reversal of Renal Failure after Revascularization in Atheromatous Renovascular Disease

Cases

Campistol²,

Abad³

et al. 1988

Am J Nephrol

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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.

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Reversal of Renal Failure by Revascularisation of Kidneys With Thrombosed Renal Arteries

Cited by 41 publications

References 7 publications

Renal Functional Recovery 47 Days after Renal Artery Occlusion

Renal Functional Recovery 47 Days after Renal Artery Occlusion

Accelerated hypertension in a 64-year-old white woman.

Reversal of Renal Failure after Revascularization in Atheromatous Renovascular Disease

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