Which features predict successful restoration of renal function after revascularization in renal artery stenosis (RAS)?

Updated: Nov 02, 2020
  • Author: Bruce S Spinowitz, MD, FACP; Chief Editor: Vecihi Batuman, MD, FASN  more...
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Answer

One unresolved issue is how to determine whether revascularization will salvage kidney function when the renal artery is totally occluded. Features that may predict successful restoration of kidney function include the following:

  • Collateral circulation and nephrogram on angiography findings
  • Kidney length longer than 9 cm
  • Lateralization of renin secretion
  • Differential concentration of urine on split-function study results
  • Spontaneous back-bleeding findings after arteriotomy during surgery
  • Viable nephrons on biopsy tissue examination

Specialists suggest nephrectomy as a modality of treatment in persons with unilateral renovascular disease (RVD). However, in one study that involved 95 hypertensive patients and 100 kidneys with chronic atherosclerotic renal artery occlusion, nephrectomy versus revascularization provided equivalent estimated survival and blood pressure benefits, but in patients treated for unilateral disease, improvement in kidney function was observed only after revascularization. Moreover, improved kidney function was significantly and independently associated with improved survival. Those authors reserved nephrectomy for a surgically unreconstructible renal artery to a poorly functioning kidney. [34]


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