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Renal revascularization in patients on dialysis
M Wengrovitz1, D A Healy, J R Diamond
1Department of Surgery, Pennsylvania State University College of Medicine, Hershey, USA.
The Journal of Cardiovascular Surgery
|June 1, 1995
Summary
Surgical revascularization can restore kidney function in some dialysis patients with renal artery disease. Patients with oliguria showed better outcomes than those who were anuric, highlighting the importance of patient selection.
Area of Science:
- Nephrology
- Cardiovascular Surgery
- Interventional Radiology
Background:
- Severe renal artery occlusive disease can lead to acute pulmonary edema and uremia, necessitating dialysis.
- Surgical revascularization is a potential treatment option for patients with end-stage renal disease due to renal artery stenosis.
Observation:
- Five patients requiring dialysis for acute pulmonary edema and uremia underwent surgical revascularization.
- Three patients with oliguria achieved dialysis independence post-operation, while two anuric patients remained dialysis-dependent despite technically successful procedures.
Findings:
- Oliguria, patent distal vessels, and a positive nephrogram on angiography predict better outcomes after renal revascularization.
- Predicting surgical response remains challenging, but renal function recovery is possible even in hemodialyzed patients.
Implications:
- An algorithm including history, physical, urinalysis, renal ultrasound, duplex scan, and potentially arteriography can aid in identifying suitable candidates for renal revascularization.
- Careful patient selection is crucial for optimizing outcomes in renal revascularization for severe renal artery occlusive disease.