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Revascularization of the poorly functioning kidney

R H Dean, J D Lawson, J W Hollifield

    Surgery
    |January 1, 1979
    PubMed
    Summary
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    Renal revascularization significantly improves kidney function and hypertension in patients with poor excretory function. Patent distal vessels on angiography predict successful outcomes, supporting aggressive treatment for renovascular hypertension.

    Area of Science:

    • Nephrology
    • Vascular Surgery
    • Hypertension Management

    Background:

    • Renovascular hypertension significantly impairs renal function.
    • Secondary renovascular hypertension often presents with poor preoperative excretory function.

    Purpose of the Study:

    • To evaluate the effect of renal revascularization on renal function in patients with severely compromised preoperative excretory capacity.
    • To identify predictors of successful outcomes in patients undergoing revascularization for renovascular hypertension.

    Main Methods:

    • Split renal function studies (SRFS) were used to assess preoperative and postoperative renal function in 25 patients.
    • Patients had preoperative creatinine clearance < 30 ml/min and underwent renal revascularization for secondary renovascular hypertension.

    Related Experiment Videos

  • Angiography was used to characterize renal artery lesions and assess distal vessel patency.

    • Main Results:

    • Postoperative creatinine clearance improved significantly, particularly in kidneys with preoperative clearance < 20 ml/min (P < 0.01).
    • Successful hypertension management (improvement or cure) was achieved in 96% of patients.
    • Patent distal vessels without severe intrarenal stenoses on angiography were the most reliable predictor of successful outcomes.

    Conclusions:

    • Renal revascularization is effective in improving renal function and managing hypertension, even in kidneys with minimal or absent preoperative excretory function.
    • Aggressive surgical intervention is warranted for patients with renovascular hypertension and poor renal function.
    • Angiographic assessment of distal vessel patency is crucial for predicting treatment success.