It Is Possible to Save the Kidney With Renal Artery Occlusion Without Autotransplantation: A Case Report

Renal artery stenosis is a rare but important cause of renovascular hypertension in children that may lead to malignant hypertension and renal failure. A 13-year-old girl presented with malignant hypertension and acute kidney injury, and imaging demonstrated occlusion of both renal arteries. Endovascular recanalization was unsuccessful because of complete, heavily fibrotic occlusions involving a long segment of the right renal artery extending to the hilum, leaving no suitable distal artery for reconstruction, and a 7.3-mm segment of the left renal artery at its aortic origin. To preserve renal function, surgical revascularization was performed by in situ reimplantation of the left renal artery into the aorta, without autotransplantation. Postoperatively, renal function recovered, the proteinuria present at admission regressed, and the patient became normotensive without antihypertensive medication.