Dean R H, Englund R, Dupont W D, Meacham P W, Plummer W D, Pierce R, Ezell C
Ann Surg. 1985 Sep;202(3):367-75. doi: 10.1097/00000658-198509000-00015.
Results of renal revascularization for retrieval of function in poorly functioning kidneys are variable, but criteria for prediction of benefit and patient selection for operation are ill-defined. This report examines preoperative parameters in 64 hypertensive patients who underwent successful revascularization of poorly functioning kidneys as defined by creatinine clearance less than or equal to 15 ml/min (measured by preoperative split renal function studies [SRFS]) or preoperative serum creatinine greater than or equal to 3.5 mg/dl (range: up to 8.9 mg/dl) to identify markers of value in prediction of a beneficial response in renal function. Ages ranged from 35 to 75 years. There were 35 men and 29 women. The renovascular lesion was atherosclerotic in 58 patients and fibrodysplastic in six. Total renal artery occlusion was present in 32 cases. No urine flow was detectable before surgery on SRFS from 13 kidneys. Kidney lengths ranged from 7.7 cm to 15.1 cm. Fifty-four unilateral and 10 bilateral revascularizations were performed. A beneficial blood pressure response to operation was observed in 94%. Benefit in excretory function was determined by comparison of preoperative and postoperative data which included SRFS parameters, renal length, serum creatinine, isotopically derived split functioning renal mass, and glomerular filtration rates. Overall, 56 patients could be classified in regard to functional response. Twenty-two patients received no or minimal benefit; nine patients received modest improvement, and 25 patients exhibited more marked improvement. Statistical evaluation of preoperative anatomic and functional parameters as predictors of functional response suggested that multiple variables influence the probability of function retrieval by revascularization. Useful among these predictive variables are the status of the distal vessel beyond the occlusion, the bilaterality of reconstructable disease in azotemic patients, the amount of residual renal mass available for revascularization, and the degree of hyperconcentration of nonreabsorbable solutes from the involved kidney after surgery.
为恢复功能不良肾脏的功能而进行肾血管重建的结果各不相同，但是预测获益的标准以及手术患者的选择标准尚不明确。本报告研究了64例高血压患者的术前参数，这些患者接受了成功的肾血管重建，其功能不良肾脏的定义为肌酐清除率小于或等于15 ml/分钟（通过术前分肾功能研究[SRFS]测量）或术前血清肌酐大于或等于3.5 mg/dl（范围：高达8.9 mg/dl），以确定在预测肾功能有益反应方面有价值的标志物。年龄范围为35至75岁。男性35例，女性29例。58例患者的肾血管病变为动脉粥样硬化，6例为纤维发育异常。32例存在肾动脉完全闭塞。术前SRFS显示13个肾脏术前无尿流。肾脏长度范围为7.7 cm至15.1 cm。进行了54例单侧和10例双侧肾血管重建。94%的患者术后血压得到有益反应。通过比较术前和术后数据来确定排泄功能的获益，这些数据包括SRFS参数、肾脏长度、血清肌酐、同位素衍生的分肾功能肾质量和肾小球滤过率。总体而言，56例患者可根据功能反应进行分类。22例患者未获得或仅获得极少的获益；9例患者有适度改善，25例患者有更明显的改善。对术前解剖和功能参数作为功能反应预测指标的统计评估表明，多个变量影响肾血管重建恢复功能的可能性。这些预测变量中有用的包括闭塞远端血管的状况、氮质血症患者可重建疾病的双侧性、可用于肾血管重建的残余肾质量、以及术后受累肾脏不可吸收溶质的高浓缩程度。
