REVASCULARIZATION OF THE POORLY FUNCTIONING KIDNEY

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  • 1 January 1979
    • journal article
    • research article
    • Vol. 85  (1) , 44-52
Abstract
The effect of renal vascularization on renal function in kidneys with poor preoperative excretory function is summarized. Patients (25) with kidneys having preoperative creatinine clearance of < 30 ml/min, determined by split renal function studies (SRFS), were revascularized for treatment of secondary renovascular hypertension and then reevaluated by SRFS. Of 13 male and 12 female patients, renal artery lesion was atherosclerotic in 21 and fibromuscular dysplastic in 4. Eight had total renal artery occlusion. Significant contralateral renal artery disease was present in 15 patients (60%). Preoperative creatinine clearance in the affected kidney ranged from 0.27 ml/min (mean, 16 .+-. 9 ml/min). After operation, creatinine clearance ranged from 0-71 ml/min (mean, 32 .+-. 16 ml/min). Of the 16 kidneys with preoperative creatinine clearance < 20 ml/min, 15 had improved renal function after revascularization (P < 0.01). Improved (60%) or cured (36%) hypertension followed revascularization in 24 patients. The most dependable predictor of successful management of hypertension and retrieval of renal function was arteriographic demonstration of a patent distal vessel without severe intrarenal stenoses. Revascularization in the operative treatment of renovascular hypertension, even when residual excretory function is minimal or absent, is recommended.