[Renal failure caused by renal artery stenosis: effects of revascularization]

From 1972 to 1986, 22 patients underwent surgical treatment for severe renovascular hypertension and rapidly progressive renal failure caused by atherosclerotic disease of the renal artery or dysplasia (group A), or by post-transplant renal artery stenosis (group B). 1. Group A (n = 16): These patients were assessed preoperatively with the measurement of serum creatinine and blood-urea levels (means 271 +/- 204 mumol/l and 15.6 +/- 10.3 mmol/l respectively) and renal clearances. 5 patients underwent aorto-renal bypass (bilateral in one case) and 11 patients were treated by autotransplantation of the kidney. Operative mortality was 6.2%. Improvement in renal function was statistically significant at 1 and 6 months postoperatively (p less than 0.05). After a mean follow-up of 31 +/- 12 months, renal function was normal in 8 patients, improved in 4, unchanged in 1 and worse in 2. At short and long-term, 81% of the patients were normotensive without medication of with an improved blood pressure (p less than 0.001). 2. Group B (n = 6): Transplant revascularisation was performed on average 10 +/- 8 months after renal transplantation. 5 patients had renal function impairment (mean serum creatinine 241 +/- 96 mumol/l, mean blood-urea 16 +/- 17 mumol/l) and 1 patient a posttransplant anuria. Resection of anastomotic (n = 2) or post-anastomotic (n = 4) lesions was carried out in all case with a new anastomosis (n = 2) or a "crossed" anastomosis (n = 4). On the 24th hour one patient underwent a second revascularization because of immediate postoperative anuria secondary to another anastomotic stenosis.(ABSTRACT TRUNCATED AT 250 WORDS)