May J, Sheil A G, Horvath J, Tiller D J, Johnson J R
Surg Gynecol Obstet. 1976 Sep;143(3):411-3.
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.
对肾功能恶化或高血压控制不佳的患者进行动脉造影检查的结果显示，肾动脉血栓形成是一种常见的加重因素。17例有一条或多条肾动脉闭塞的患者接受了手术，以改善肾功能或控制高血压。除4例患者肾动脉闭塞外，对侧肾动脉还存在狭窄。15例患者接受了动脉重建手术，2例患者接受了肾切除术。8例肾衰竭患者在闭塞肾动脉血运重建后肾功能有显著改善。该组患者术前血清肌酐平均值为7.95±1.81（标准误）毫克/百分，术后平均随访20个月时降至3.91±1.21（标准误）毫克/百分。17例患者中有16例术前难以控制高血压。术后，6例患者血压降至正常水平，另有8例患者在服用抗高血压药物后血压降至正常水平。2例患者的高血压情况未改变。对14例高血压患者测量了血浆肾素活性。13例患者升高，1例患者正常。术后，血浆肾素活性正常的患者血压未改变，但13例血浆肾素活性升高的患者中有12例血压恢复到正常水平。得出的结论是，肾动脉闭塞的患者应接受手术治疗。积极治疗这种疾病的主要益处是逆转肾衰竭和控制高血压。
