RENAL REVASCULARIZATION IN PATIENTS ON DIALYSIS

Five patients requiring dialysis for acute pulmonary edema and uremia from severe renal artery occlusive disease underwent surgical revascul arization. Three patients with oliguria had excellent outcomes and rem ain dialysis-independent as long as twenty-four months following opera tion (mean serum creatinine 2.0 mg/dl). The two patients who were anur ic both had technically successful operations but remained dialysis-de pendent, Diagnostic evaluation of the azotemic patient suspected to ha ve renal arterial occlusive disease should include a history and physi cal examination, urinalysis, renal ultrasound, and duplex scan of the renal arteries. In appropriate patients, arteriography should then be considered if other diagnoses appear unlikely. This algorithm may help identify those patients who might benefit from renal revascularizatio n. It appears that oliguria rather than anuria and the angiographic de monstration of a patent distal vessel and nephrogram suggest a better functional outcome after revascularization. Unfortunately, the respons e to surgery cannot be reliably predicted and patient selection remain s a challenge, but retrieval of renal function can be achieved in some cases even if patients are already being hemodialyzed.