[Kidney revascularization and function recovery in patients in dialysis]

The available literature was reviewed to analyze the indications and results of the surgical restoration of flow to ischemic kidneys in dialyzed patients with ischemic nephropathy. Only 57 were found, a small number compared with the estimated percentage (5 to 15%) of ischemic insufficiency in dialyzed patients. Atherosclerosis was the main cause of ischemia and most patients were over the seventh decade of life. Common clinical findings were uncontrolled hypertension and/or acute cardiac failure, symptomatic atherosclerotic disease in other areas and rapid deterioration of renal function. Kidneys recovered after variable periods of ischemia (days to 13 months of dialysis, mean 30.5 days), with small size, 9, 8 or even 7 cm, absent nephrograms of flat flow curves in isotopic studies or without distal arteries and/or collaterals in the angiogram. Total arterial occlusion was more frequent than stenosis. After surgery the patients recovered immediately (35%) or required transitory dialysis (52%); in a few (12.2%) function was not restored. Hypertension improved or was cured in almost all patients. The good results persisted during long periods. A better knowledge of the disease, early detection and treatment, will improve the quality of life and survival of patients with ischemic nephropathy.