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Improvement of renal function in azotaemic hypertensive patients after surgical revascularization
C A Mestres1, J M Campistol, S Ninot
1Department of Cardiovascular Surgery, Hospital Clínico y Provincial, University of Barcelona, Spain.
Insights
Surgical renal revascularization significantly improved kidney function and lowered blood pressure in patients with renovascular disease. This effective treatment is recommended for selected cases of renal failure.
Area of Science:
- Nephrology
- Cardiovascular Surgery
- Vascular Medicine
Background:
- Renal insufficiency and severe hypertension are often linked to renovascular disease.
- Patients with worsening renal function and uncontrolled hypertension require effective interventions.
Purpose of the Study:
- To evaluate the efficacy of surgical renal revascularization in patients with renal insufficiency and renovascular hypertension.
- To assess the impact of surgical intervention on renal function and blood pressure control.
Main Methods:
- A cohort of 17 patients with renal insufficiency and severe hypertension underwent various surgical renal revascularization procedures between 1974 and 1986.
- Primary causes of renal stenosis were atherosclerosis (14 cases) and fibromuscular dysplasia (3 cases).
- Procedures included splenorenal shunt, autotransplantation, aortorenal bypass, hepatorenal bypass, bilateral renal endarterectomy, renal ostial closure, and nephrectomy.
Main Results:
- Mean serum creatinine decreased significantly from 3.76 to 1.65 mg/dl (P < 0.005).
- Mean arterial pressure dropped substantially from 161 to 103 mmHg (P < 0.001), with significant reductions in systolic and diastolic pressures.
- Two patients died post-operatively; four required secondary procedures for improved outcomes.
Conclusions:
- Renovascular disease should be considered in patients with renal insufficiency and hypertension, even those on hemodialysis.
- Renal revascularization surgery is a reliable and effective treatment for selected patients with renal failure of renovascular origin.
Abstract:
Between 1974 and 1986, 17 patients (16 men and 1 woman) with renal insufficiency (serum creatinine greater than 1.5 mg/dl, mean 3.75 mg/dl), with a mean age of 51.3 years, underwent surgical renal revascularization. Two of them were on maintenance haemodialysis. All were severely hypertensive in spite of antihypertensive drugs. Atherosclerosis was the cause of renal stenosis in 14 cases and fibromuscular dysplasia in 3. Operative procedures included splenorenal shunt (5), autotransplantation (3), aortorenal bypass (3), hepatorenal bypass (1), bilateral renal endarterectomy (1), renal ostial closure (1) and nephrectomy (3). Mean serum creatinine showed a decrease from 3.76 to 1.65 mg/dl (P less than 0.005). Mean arterial pressure dropped from 161 mmHg to 103 mmHg (P less than 0.001). Systolic and diastolic pressures also showed significant decreases. Two patients died. Four patients required a second operation and the renal function and blood pressure then improved. Renovascular disease must be ruled out in patients with renal insufficiency associated with hypertension, including those patients on haemodialysis. We conclude that renal revascularization surgery is a reliable and efficient form of treatment in selected cases of renal failure of renovascular origin.