title: A transplanted kidney surviving total vessel occlusion and anuria.
abstract: We report a case of a 46-year-old white male with renal graft artery stenosis who developed acute renal shutdown with total anuria while on the ACE inhibitor lisinopril, one week following the discontinuation of aspirin. The serum creatinine was 8.5 mg/dl. Doppler ultrasound and MAG3 scintigraphy of the grafted kidney were highly suggestive of a viable but nonfunctioning kidney. A femoro-femoral bypass for total thrombosis of the right common iliac artery was performed distal to the occlusion. Immediate diuresis was obtained after establishing the bypass. Serum creatinine dropped to 1.35 mg/dl three days later. In this case we believe that the collateral circulation played a significant role in immediate recovery of kidney function by maintaining renal perfusion pressure and preventing acute tubular necrosis (ATN). We also believe that the ACE inhibitor might have contributed to salvaging the kidney by improving medullary oxygen balance and maintaining adequate medullary blood flow.
authors.affiliation: Department of Medicine, Staten Island University Hospital, 475 Seaview Ave, Staten Island, NY 10305, USA. mdharake@hotmail.com
authors.forename: M A
authors.initials: MA
authors.lastname: El-Harakeh
authors.forename: A
authors.initials: A
authors.lastname: Barbari
authors.forename: A
authors.initials: A
authors.lastname: Stephan
authors.forename: S
authors.initials: S
authors.lastname: Saggi
authors.forename: H
authors.initials: H
authors.lastname: Kilany
authors.forename: A
authors.initials: A
authors.lastname: Barakeh
mesh_terms: D001002:Anuria / Q000209:etiology* / Q000601:surgery*; D006085:Graft Survival; D006801:Humans; D007676:Kidney Failure, Chronic / Q000601:surgery; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D012078:Renal Artery Obstruction / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery