Revascularization of the ischemic kidney
J. B. Towne and V. M. Bernhard
Although acute renal artery obstruction causes cessation of kidney
function, the viability of the nephron is often maintained by collateral
circulation. When renal artery blood flow is restored, filtration is
resumed and the resulting acute tubular necrosis is gradually resolved as
renal tubular cells regenerate. We have observed several different
mechanisms of acute renal artery obstruction resulting in anuric renal
failure: temporary suprarenal placement of an aortic clamp during absominal
aneurysmectomy, resulting in bilateral renal artery occlusion; embolus,
presumably of cardiac origin, to a solitary kidney; and thrombosis of the
distal aorta extending to a level proximal to the renal arteries. There is
no correlation between the duration of renal artery occlusion and the
viability of kidney parenchyma. Viability of the kidney can only be
determined by visual inspection at operation and response to
revascularization. When vascular obstruction is a possible cause of acute
anuric renal failure, immediate angiography is indicated. If a correctable
vascular lesion is identified, operative intervention is mandatory.
