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Anatomic and Renal Function Changes During Drug Therapy

Richard H. Dean, MD; Robert W. Kieffer, MD; Bruce M. Smith, MD; John A. Oates, MD; John H. J. Nadeau, MD; John W. Hollifield, MD; William D. DuPont, PhD

Arch Surg. 1981;116(11):1408-1415.

Abstract
• Serial renal function studies were performed on 41 patients with renovascular hypertension (RVH) secondary to atherosclerotic renal artery disease who had been randomly selected for nonoperative management. In 19 patients, serum creatinine levels increased between 25% and 120%. The glomerular filtration rates dropped between 25% and 50% in 12 patients. Fourteen patients (37%) lost more than 10% of renal length. In four patients (12%), a significant stenosis progressed to total occlusion. Seventeen patients (41%) had deterioration of renal function or loss of renal size that led to operation. One patient required removal of a previously reconstructable kidney. Of the 17 patients with deterioration, 15 had acceptable blood pressure (BP) control during the period of nonoperative observation. Progressive deterioration of renal function in nonoperatively treated patients with atherosclerotic renal artery stenosis and RVH is common, and occurs even in the presence of BP control with drugs.

(Arch Surg 1981;116:1408-1415.

Author Affiliations
From the Division of Vascular Surgery (Drs Dean, Kieffer, and Smith) and the Specialized Center for Research in Hypertension (Drs Dean, Oates, Nadeau, Hollifield, and DuPont), Vanderbilt University Medical Center, Nashville, Tenn.

Footnotes
Accepted for publication July 13, 1981.

Read at the 29th scientific meeting of the International Cardiovascular Society, Dallas, June 11, 1981.

Reprint requests to Department of Surgery, Vanderbilt University School of Medicine, Nashville, TN 37232 (Dr Dean).

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