Reversible renal failure following bilateral renal artery occlusive disease. Clinical features, pathology, and the role of surgical revascularization

Abstract

Patients 3 with severe hypertension and rapidly progressive oliguric renal failure who required dialysis were found by aortography to have bilateral renal artery occlusion or stenosis. Each had peripheral arteriosclerosis or an abdominal bruit. Following renal artery reconstructive surgery, all 3 patients recovered nearly normal renal function in 3-12 wk, though mild hypertension persisted in 2 patients. The common findings of a normal-sized kidney with collateral blood flow and nearly normal histological features were predictive of recovery of renal function. Prolonged postoperative oliguria in 2 patients may have been due to increased preglomerular vascular resistance mediated by the renin-angiotensin system.