title: Surgical salvage of acute renal artery occlusion in the setting of a solitary kidney.
abstract: Management of acute renal artery occlusion in patients with a solitary kidney has a poorly defined prognosis. Loss of renal function is reported by some when acute warm ischemia reaches 2 hours. We report a unique case of a patient that had a 24-hour onset of anuria and acute renal failure upon arrival to the hospital. Nuclear imaging showed trace uptake of the right kidney, without evidence of excretion. Conventional digital subtraction angiography was performed; however, evidence of nephrogram or distal filling of the renal artery was not demonstrated. Secondary to conflicting studies, a computed tomography of the abdomen and pelvis with intravenous contrast revealed only minimal cortical perfusion despite complete occlusion of the previously grafted right renal artery. Patient was taken for urgent hepatorenal bypass surgery. Intraoperative return of urine output occurred immediately after completion of the bypass. Hemodialysis, which was required preoperatively, was stopped after <30 days of bypass procedure. Over 2 years following successful renal salvage, the patient has maintained a normal glomerular filtration rate and patency of her bypass by duplex follow-up.
authors.affiliation: West Virginia University, Charleston Division, Department of Surgery, Division of Vascular and Endovascular Surgery, Charleston, WV, USA.
authors.forename: Patrick
authors.initials: P
authors.lastname: Stone
authors.forename: Adam S
authors.initials: AS
authors.lastname: Mossalllati
authors.forename: Haley
authors.initials: H
authors.lastname: Schlarb
authors.forename: Chris
authors.initials: C
authors.lastname: Schlarb
mesh_terms: D000208:Acute Disease; D058186:Acute Kidney Injury / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy; D000368:Aged; D015901:Angiography, Digital Subtraction; D002405:Catheterization, Central Venous; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007511:Ischemia / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D007668:Kidney / Q000098:blood supply* / Q000503:physiopathology; D055420:Perfusion Imaging / Q000379:methods; D020127:Recovery of Function; D012078:Renal Artery Obstruction / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D006435:Renal Dialysis; D012501:Saphenous Vein / Q000637:transplantation*; D013927:Thrombosis / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D058017:Vascular Grafting
keywords: hepatorenal; renal rescue; solitary kidney