Restoration of Kidney Function after Prolonged (Four Months)Anuria Due to Bilateral Renal Artery Occlusion

Abstract

Introduction: Atherosclerotic renal artery stenosis (RAS) is usually one manifestation of wide spread atherosclerotic disease and its presence has a grave impact on prognosis. RAS is a progressive condition that can remain asymptomatic for a long time, only to present later with accelerated hypertension or renal insufficiency. The first approach to the management of atherosclerotic RAS consists of medical therapy to control blood pressure and other atherosclerotic risk factors. However, surgical or percutaneous revascularization can be of substantial benefit in selected patient groups.
Case Report: A 37 year old man who was a heavy smoker and known to have hypertension for the previous five years presented with acute anterior myocardial infarction (MI). His serum creatinine was 8.5 mg/dl and he needed a session of acute peritoneal dialysis to relieve severe pulmonary edema. Subsequent investigations revealed the presence of bilateral total occlusion of the renal arteries resulting in severe renal impairment and dialysis dependency. He underwent two unsuccessful attempts at angioplasty. Surgical revascularization of both renal arteries was eventually carried out after four months of anuria, and was immediately followed by dramatic improvement of his kidney function. The patient, however, continued to receive antihypertensive medication for adequate blood pressure control.
Conclusion: This case reflects the ability of the kidney to adapt to chronic ischemia, and underscores the importance of considering renal revascularization in all patients with renal artery occlusion, even after long periods of kidney non-functioning.

Key words: renal artery occlusion, renaovascular disease, renal revascularization, ischemic nephropathy