Treatment of acute renal failure caused by renal artery occlusion with renal artery angioplasty.
BACKGROUND
Renovascular disease is a common cause of renal impairment and hypertension, particularly in the older population. Oligoanuric acute renal failure secondary to renal artery occlusion is not well recognized; however, it is potentially reversible if identified and treated.


METHODS
Five patients presented to our institution with oligoanuric acute renal failure. Each had evidence of vascular disease, and a prerenal insult was identified. They were investigated with renal artery Doppler ultrasound or nuclear imaging before proceeding to percutaneous angioplasty and stent placement.


RESULTS
The targeted kidney had relatively well-preserved renal size, and potential viability of the renal tissue was determined by nuclear scanning with parenchymal uptake of tracer. Percutaneous angioplasty and stent placement resulted in brisk reperfusion of the kidney and an immediate diuresis with improvement of renal function, avoiding supportive dialysis after the procedure. Contrast nephrotoxicity was identified in two of the five cases.


CONCLUSIONS
Renal artery occlusion should be considered as a cause of oliguric acute renal failure, particularly in patients at high risk who present with a sudden deterioration of renal function, with nuclear imaging showing potentially viable renal tissue with relatively well-preserved renal size. Percutaneous revascularization should be considered in this group.
Dwyer
Karen M
KM
Department of Nephrology, St.Vincent's Hospital, Melbourne, Australia. dwyerkm@svhm.org.au
Vrazas
John I
JI
Lodge
Robert S
RS
Humphery
Timothy J
TJ
Schlicht
Stephen M
SM
Murphy
Brendan F
BF
Mossop
Peter J
PJ
Goodman
David J
DJ
D000208:Acute Disease; D058186:Acute Kidney Injury / Q000000981:diagnostic imaging / Q000601:surgery*; D000368:Aged; D000369:Aged, 80 and over; D017130:Angioplasty / Q000379:methods*; D001157:Arterial Occlusive Diseases / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D006801:Humans; D007668:Kidney / Q000098:blood supply / Q000000981:diagnostic imaging / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011866:Radioisotope Renography / Q000379:methods; D012077:Renal Artery / Q000000981:diagnostic imaging / Q000601:surgery*; D014463:Ultrasonography