1978 Volume 69 Issue 8 Pages 1019-1027
From January, 1969 to January, 1977, 9 patients including 7 females between 19 and 44 years of age were found to have renovascular hypertension due to unilateral fibromuscular dysplasia of the main renal artery. All patients were subjected to renal autotransplantation either as a primary or secondary surgical procedure in addition to ex vivo reconstructive surgery in 4 patients.
In two of the nine patients autotransplantation was performed secondarily after initial bypass procedure with Teflon graft had failed, however it was a procedure of choice in the remaining seven patients. Anatomical success was confirmed by postoperative renal angiography in all but one, who had an intrarenal calcified aneurysm as well as a stricture of the main renal artery. Their location made it extremely difficult to excise the aneurysm even in ex vivo procedure, and resulted in a failure due to thrombosis. Subsequently the autotransplanted kidney was removed two weeks after the initial surgery.
Normalization of blood pressure was observed in all 9 patients within 10 to 48 days after surgery (mean, 21.6 days), and 8 patients could meet the criteria for cure used by Kaufman & Mexwell (1964) in judging the effect of the operative procedure on the blood pressure, namely blood pressure of 140/90mmHg or less, one year postoperatively.
Screening the patients with renovascular disease was initiated with safe and inexpensive diagnostic modalities including rapid sequence urogram (RSIP) and radioisotope renogram. Those patients with positive result after the screening were hospitalized for further investigation. Although arteriography is quite useful to visually demonstrate suspicious renal arterial lesion, functional significance of the lesion and/or operative prognosis were determined utilizing split renal function test (SRF), renal vein renin ratio (RVRR) and Angiotensin II (Ang II) analogue test. Plasma renin activity was determined by means of Skinner's bioassay instead of the radioimmunoassay. Ang II analogue test was conducted by infusion of 300ng/kg/min. of 1 Sarcosin 8 Isoleucin Ang II for 30 minutes and blood pressure was determined pre and post infusion. The predictive accuracy of operative prognosis of the SRF, RVRR and Ang II analogue test were 100%, 66% and 80%, respectively. Based on this study it is our conclusion that the autotransplantation should be more frequently utilized as an excellent therapeutic modality for renovascular hypertension. Emphasis is placed that a decision should be made for, or against, operative treatment based on multifacet analysis of SRF, RVRR and Ang II analogue test.
