Towne J B, Bernhard V M
Arch Surg. 1978 Feb;113(2):216-8. doi: 10.1001/archsurg.1978.01370140106024.
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.
尽管急性肾动脉阻塞会导致肾功能停止，但肾单位的活力通常可通过侧支循环得以维持。当肾动脉血流恢复时，滤过功能会重新开始，随着肾小管细胞再生，由此产生的急性肾小管坏死会逐渐得到解决。我们观察到几种不同机制导致的无尿性肾衰竭的急性肾动脉阻塞情况：腹主动脉瘤切除术中在肾上腺上方临时放置主动脉夹，导致双侧肾动脉闭塞；栓子（推测源自心脏）栓塞至单肾；以及远端主动脉血栓形成并延伸至肾动脉近端水平。肾动脉阻塞的持续时间与肾实质的活力之间没有相关性。肾脏的活力只能通过手术中的肉眼观察以及对血管再通的反应来确定。当血管阻塞可能是急性无尿性肾衰竭的病因时，应立即进行血管造影。如果发现可纠正的血管病变，则必须进行手术干预。
