Renovascular hypertension and renal insufficiency treated with left nephrectomy and right autotransplantation

A patient presented with renal failure and severe hypertension. Arteriography showed a non-functioning kidney due to occlusion of the renal artery. The artery of the other contralateral kidney seemed unaffected. Converting enzyme inhibition resulted in normalization of the blood pressure, but this was accompanied by worsening of the renal failure. This was the clue for the detection of an origostenosis of the artery of the contralateral kidney, which could only be diagnosed by oblique angiograms. A revascularisation procedure by renal autotransplantation was performed. Simultaneously the non-functioning kidney was excised. The procedure resulted in an uneventful recovery of renal function. Diagnostic and therapeutic issues are discussed.