Reversal of renal failure and control of hypertension in patients with occlusion of the renal artery.

Results of arteriographic investigation of patients with deteriorating renal function or poorly controlled hypertension have revealed that thrombosis of the renal artery is not an uncommon exacerbating factor. Seventeen patients with one or more occluded renal arteries had an operation to improve renal function or to control hypertension. Stenosis of the contralateral renal artery was present in addition to the occlusion in four patients. Reconstructive arterial procedures were performed in 15 patients and nephrectomy was performed in two. Eight patients with renal failure had marked improvement in renal function after revascularization of the occluded renal arteries. The group had a mean preoperative serum creatinine value of 7.95+/-1.81 (S.E.) milligrams per cent which fell postoperatively to 3.91+/-1.21 (S.E.) milligrams per cent at a mean follow-up period 20 months. Preoperative control of hypertension was difficult in 16 of the 17 patients. Postoperatively, the blood pressure fell to normal levels in six patients, and in an additional eight patients, it did so with the administration of antihypertension therapy. The hypertension was unchanged in two patients. Plasma renin activity was measured in 14 of the patients with hypertension. It was elevated in 13 patients and normal in one patient. Postoperatively, the blood pressure was unchanged in the patient with normal plasma renin activity, but in 12 of the 13 patients with elevated plasma renin activity, the blood pressure returned to normal levels. It is concluded that patients with occluded renal arteries should be treated surgically. The major benefits of an aggressive approach to this condition are reversal of renal failure and control of hypertension.