Case Reports
Treatment of acute renal failure caused by renal artery occlusion with renal artery angioplasty

https://doi.org/10.1053/ajkd.2002.33929Get rights and content

Abstract

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. Conclusion: 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. © 2002 by the National Kidney Foundation, Inc.

Section snippets

Case 1

A 61-year-old woman had a history of right renal artery stenting 2 years prior for hypertension. A small left kidney was noted. Comorbidities included type 2 diabetes mellitus, hypertension, and hypercholesterolemia. Baseline serum creatinine was 1.5 mg/dL (0.13 mmol/L). She was not treated with an ACE inhibitor. She presented with uremic symptoms after a diarrheal illness. Her urine output was 500 mL/d despite adequate volume replacement with serum creatinine of 6.1 mg/dL (0.54 mmol/L). She

Discussion

ARVD is a common cause of renal impairment and hypertension9 in the elderly population (median age, 60 to 70 years).11, 12, 13 High-risk patients are those who have clinical manifestations of atheroma at extrarenal sites, such as the aorta or cardiac, cerebral, or peripheral circulations.11, 12, 14, 15 The prevalence of ARVD was reported as 25% in patients having routine coronary angiography and 50% in patients having peripheral angiography.2, 4, 5, 6, 7, 9, 15, 16 Lesions are bilateral in 50%

References (29)

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    Patients with ARVD may develop ARF in association with cholesterol atheroemboli, hypovolemia induced acute tubular necrosis, contrast nephropathy but the commonest presentation is with concomitant ACE-I or ARB use in patients with bilaterally significant RAS or in previously stable RAS patients who become hypovolaemic. Anuric ARF rarely complicates ARVD [2,7] but when it does it is most often associated with acute RAO as a result of thrombosis or with a critical stenosis with/without the effects of ACE-I or ARBs. In order for the anuria to supervene this pathology is likely to be bilateral or present in a previously solitary functioning kidney (as in our case).

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Address reprint requests to Karen M. Dwyer, MB, BS, FRACP, Department of Nephrology, 41 Victoria Parade, Fitzroy, 3065, Victoria, Australia. E-mail: [email protected]

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