THE IMPACT OF RENAL REVASCULARIZATION ON RENAL DYSFUNCTION

Aim: To determine the value of kidney revascularisation in patients wi th impaired venal function and correctable venal artery stenosis, the authors reviewed their surgical experience from 1978 to 1990. Patients and Methods: The study population included 23 patients with ischaemic nephropathy whose preoperative baseline creatinine level exceeded 20 mg/l (range 21-65 mg/l). This represents 20% of all patients operated on for renal artery disease during the same time interval. Preoperativ e risk profile, operative mortality, impact on hypertension and on ven al function, and late survival were analysed. Renal function response to kidney revascularisation was defined as favourable (20% or more red uction of serum creatinine), moderate (stabilised serum creatinine val ues) or bad (further deterioration of venal Junction). Ail patients ha d atherosclerotic venal artery disease, involving a solitary kidney in five, both kidneys in 15 and one of the two kidneys in three patients . Hypertension was present in 74%. Revascularisation tons unilateral i n 10, bilateral in nine and associated with controlateral nephrectomy in four patients. Results: Four patients died postoperatively (three m yocardial infarctions, one stroke). Four patients needed postoperative short-term dialysis. After operation, renal function improved in 13, stabilised in six and deteriorated in four patients (of whom two died) . Follow-up among the survivors averaged 46 months. The mean serum cre atinine valve at last follow-up visit was 26.2 mg/l, a decrease of 7.7 mg/l compared to preoperative values (p < 0.05). Overall, 69% of azot emic patients submitted to renal revascularisation manifested a favour able response (45% improved and 24% stabilised). Three patients requir ed long-term dialysis. The 5-year survival rate was 48%. Conclusion: T hese data suggest that kidney revascularisation in patients with ischa emic nephropathy can restore or stabilise renal function, preventing e volution and end-stage venal disease and dialysis dependency.