[Acute renal artery occlusion. Origin, diagnosis, possibilities of treatment]

Although acute renal artery occlusion is luckily a rare event, many cases are probably overlooked. They are caused either by emboli, accidents or iatrogenic vascular injury. The conventional wisdom holds that the kidney is irreversibly damaged by arterial obstruction lasting several hours, but clinical experience shows that there are exceptions to this rule. How this is to be explained from the pathophysiologic viewpoint is discussed in this article. Recognition of acute renal artery occlusion is easiest and fastest in iatrogenic cases. In trauma due to accidents, useful pointers are hematuria, site and intensity of the injuring force and concomitant lesions. Emboli do not give rise to specific symptoms and are most to be suspected in cases prone to embolism. It is helpful to subdivide renal artery occlusions into two groups, one with and the other without mural lesionsof the artery. The outlook is a priori considerably better in cases with intact vascular wall. Here, i.e. in the presence of fresh or recent thrombo-embolic occlusion, surgery is most likely to prove successful, but conservative management alone is known to afford good results too. A differentiated approach to treatment is outlined. Severe vascular trauma may confront the surgeon with virtually insoluble problems, but the conditions under which surgical intervention is nonetheless recommended are defined. Generally the presence of a normal conttalateral kidney will lessen the need for surgical action. Surgery is however mandatory in the none too rare case of bilateral renal artery occlusion or when a solitary kidney is affected. In these cases in-situ perfusion combined with organ cooling, explantation, reconstructive surgery extra vivum and heterotopic re-implantation (for instance into the pelvis) is a most promising procedure.