Successful Surgical Treatment of Anuria Caused by Renal Artery Occlusion

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Abstract
Anuria resulting from obstruction of the renal arteries to both kidneys or to a solitary kidney is unusual. The tolerance of the kidney to this ischemia is largely dependent on the presence of collaterals, stimulated by pre-existing arterial disease. Experienced with 6 patients with anuria caused by renal artery occlusion supports the role of revascularization in the recovery of significant renal function. Four of these patients had hypertension, impaired renal function and the existence of collateral circulation to an ischemic kidney, prior to occlusion, while 2 patients had normal renal function (serum creatinine = 0.5 and 0.9 mg/dl) before occlusion. The intervals of anuria or the 2 previously normal kidneys were 6 h and 5 days, and 2-14 days in the 4 patients with vascular disease. Isotope scanning suggested renal artery occlusion in 2 patients, but arteriograms confirmed the diagnosis in all 6. A thrombectomy restored blood flow through the 2 previously normal renal arteries. Grafts from the aorta or celiax axis were used for 3 patients and the splenic artery was used for the 6th patient. Urine flow began during or soon after operation in all patients. Dialysis was necessary for 30 and 45 days in the 2 patients with normal kidneys, but in only 1 of the 4 patients with previous disease (for 10 days). Serum creatinine decreased to < 2.0 mg/dl after operation, except in the man with a solitary kidney, who 5 yr later has a creatinine of 3 mg/dl. All 4 patients with previous arterial disease died from cardiac failure within 1-30 mo. operation. Anuria of acute onset should be evaluated by renal scan and arteriogram to detect those patients with proximal renal artery occlusion in preparation for revascularization.