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Renal revascularization in patients with a single functioning ischemic kidney
Abstract:
From 1965 to 1985, 19 patients with a single, ischemic kidney underwent renal revascularization. Thirteen patients had a single kidney and six had a single functioning kidney. The cause of the renal artery lesions was atherosclerosis in 17 patients and fibromuscular dysplasia in two. All but one were hypertensive with a mean diastolic blood pressure of 119 mm Hg and they were taking an average of 2.6 antihypertensive medications. Most had diminished renal function with a mean serum creatinine value of 3.7 mg/dl (range 0.8 to 9.0 mg/dl) and a mean creatinine clearance of 38 ml/min (range 8 to 75 ml/min). Three patients required preoperative hemodialysis. The first two patients treated died postoperatively, but no deaths have occurred since 1970. Follow-up among the survivors averaged 32.9 months. The mean serum creatinine value decreased significantly to 2.2 mg/dl postoperatively (p less than 0.04); the mean diastolic pressure decreased significantly to 86 mm Hg (p less than 0.001). One patient was normotensive preoperatively. Of the 16 patients surviving operation, 14 had improvement of their hypertension, one was cured, and only one did not benefit. No patient's hypertension was worse. The mean number of postoperative antihypertensive medications decreased significantly to 1.5 medications per patient (p less than 0.02). These data suggest that an aggressive surgical approach is warranted in patients with a single ischemic kidney in need of revascularization because of the gratifying response both in control of hypertension and improvement of renal function.
Insights
Renal revascularization significantly improves hypertension and kidney function in patients with a single ischemic kidney. This surgical approach is recommended for its positive outcomes in blood pressure control and renal health.
Area of Science:
- Nephrology
- Vascular Surgery
- Cardiology
Background:
- Single ischemic kidney presents a complex clinical challenge.
- Renal artery stenosis is a common cause of secondary hypertension and renal dysfunction.
- Patients with a single kidney are at high risk for progressive renal damage.
Purpose of the Study:
- To evaluate the efficacy of renal revascularization in patients with a single ischemic kidney.
- To assess the impact of the procedure on hypertension and renal function.
- To determine the safety and long-term outcomes of surgical intervention.
Main Methods:
- Retrospective analysis of 19 patients with single ischemic kidneys undergoing renal revascularization between 1965 and 1985.
- Patients had atherosclerosis or fibromuscular dysplasia as the cause of renal artery lesions.
- Preoperative and postoperative data on blood pressure, serum creatinine, and antihypertensive medication use were collected.
Main Results:
- Significant reduction in mean diastolic blood pressure from 119 mm Hg to 86 mm Hg (p < 0.001).
- Significant decrease in mean serum creatinine from 3.7 mg/dl to 2.2 mg/dl (p < 0.04).
- Hypertension improved in 14 of 16 survivors (87.5%), with one cure and no worsening of blood pressure.
Conclusions:
- Renal revascularization is a safe and effective treatment for single ischemic kidneys.
- The procedure leads to significant improvements in blood pressure control and renal function.
- An aggressive surgical approach is warranted for selected patients with a single ischemic kidney.