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. 1991 May;213(5):446–456. doi: 10.1097/00000658-199105000-00010

Evolution of renal insufficiency in ischemic nephropathy.

R H Dean 1, R W Tribble 1, K J Hansen 1, E O'Neil 1, T E Craven 1, J F Redding 2nd 1
PMCID: PMC1358471  PMID: 2025065

Abstract

This retrospective review of data collected during a recent 42-month period from 58 consecutive patients with ischemic nephropathy submitted to operative management in the authors' center was undertaken to report the rate of decline in their renal function during the period before intervention and to examine the impact of operation on their outcome. Based on serum creatinine values, immediate preoperative estimated glomerular filtration rates (EGFR) ranged from 0 to 46 mL/minute (mean, 23.85 +/- 9.76 mL/minute). Eight patients were dialysis dependent or anuric at the time of operation. Patients with at least three sequential measurements for calculations of EGFR changes during the 6 months before operation (n = 50) and the first 12 months after operation (n = 32) were used to describe the preoperative rate of decline in EGFR and the impact of operation on this decrease in the operative survivors. In addition comparative analyses of data from patients with unilateral versus bilateral lesions and patients classified as having improvement in EGFR versus no improvement after operation were performed. Comparison of the immediate preoperative EGFR with the immediate postoperative EGFR for the entire group showed significant improvement in response to operation. Likewise the rate of deterioration in EGFR for the total group was improved after operation. A similar improvement in the rate of deterioration in EGFR was seen in the subgroup of patients who received an immediate improvement in EGFR in response to operation. These data argue that ischemic nephropathy is a rapidly progressive form of renal insufficiency. Although individual responses to operation were heterogeneous, renal revascularization may provide both immediate improvement in renal function and an improvement in its rate of deterioration during follow-up in patients with ischemic nephropathy.

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Selected References

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  1. Bauer J. H., Brooks C. S., Burch R. N. Clinical appraisal of creatinine clearance as a measurement of glomerular filtration rate. Am J Kidney Dis. 1982 Nov;2(3):337–346. doi: 10.1016/s0272-6386(82)80091-7. [DOI] [PubMed] [Google Scholar]
  2. Bengtsson U., Bergentz S. E., Norbäck B. Surgical treatment of renal artery stenosis with impending uremia. Clin Nephrol. 1974 Nov-Dec;2(6):222–229. [PubMed] [Google Scholar]
  3. Bjornsson T. D. Use of serum creatinine concentrations to determine renal function. Clin Pharmacokinet. 1979 May-Jun;4(3):200–222. doi: 10.2165/00003088-197904030-00003. [DOI] [PubMed] [Google Scholar]
  4. Cockcroft D. W., Gault M. H. Prediction of creatinine clearance from serum creatinine. Nephron. 1976;16(1):31–41. doi: 10.1159/000180580. [DOI] [PubMed] [Google Scholar]
  5. Dean R. H., Englund R., Dupont W. D., Meacham P. W., Plummer W. D., Jr, Pierce R., Ezell C. Retrieval of renal function by revascularization. Study of preoperative outcome predictors. Ann Surg. 1985 Sep;202(3):367–375. doi: 10.1097/00000658-198509000-00015. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Dean R. H., Foster J. H. Criteria for the diagnosis of renovascular hypertension. Surgery. 1973 Dec;74(6):926–930. [PubMed] [Google Scholar]
  7. Eggers P. W. Effect of transplantation on the Medicare end-stage renal disease program. N Engl J Med. 1988 Jan 28;318(4):223–229. doi: 10.1056/NEJM198801283180406. [DOI] [PubMed] [Google Scholar]
  8. Hansen K. J., Tribble R. W., Reavis S. W., Canzanello V. J., Craven T. E., Plonk G. W., Jr, Dean R. H. Renal duplex sonography: evaluation of clinical utility. J Vasc Surg. 1990 Sep;12(3):227–236. doi: 10.1067/mva.1990.22791. [DOI] [PubMed] [Google Scholar]
  9. Mailloux L. U., Bellucci A. G., Mossey R. T., Napolitano B., Moore T., Wilkes B. M., Bluestone P. A. Predictors of survival in patients undergoing dialysis. Am J Med. 1988 May;84(5):855–862. doi: 10.1016/0002-9343(88)90063-0. [DOI] [PubMed] [Google Scholar]
  10. Novick A. C., Pohl M. A., Schreiber M., Gifford R. W., Jr, Vidt D. G. Revascularization for preservation of renal function in patients with atherosclerotic renovascular disease. J Urol. 1983 May;129(5):907–912. doi: 10.1016/s0022-5347(17)52453-2. [DOI] [PubMed] [Google Scholar]
  11. Rolin H. A., 3rd, Hall P. M., Wei R. Inaccuracy of estimated creatinine clearance for prediction of iothalamate glomerular filtration rate. Am J Kidney Dis. 1984 Jul;4(1):48–54. doi: 10.1016/s0272-6386(84)80026-8. [DOI] [PubMed] [Google Scholar]
  12. Scoble J. E., Maher E. R., Hamilton G., Dick R., Sweny P., Moorhead J. F. Atherosclerotic renovascular disease causing renal impairment--a case for treatment. Clin Nephrol. 1989 Mar;31(3):119–122. [PubMed] [Google Scholar]

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