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CLINICAL REVIEW: Alison Brammah, Sue Robertson, Graeme Tait, and Chris Isles Lesson of the week: Bilateral renovascular disease causing cardiorenal failure BMJ 2003; 326: 489-491 [Full text]

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DIAGNOSIS AND TREATMENT OF CARDIORENAL FAILURE

Einar Svarstad, Bjarne M. Iversen   (3 April 2003)

DIAGNOSIS AND TREATMENT OF CARDIORENAL FAILURE 3 April 2003
Einar Svarstad, Consultant nephrologist Haukeland University Hospital, 5021 Bergen, Norway, Bjarne M. Iversen Send response to journal: Re: DIAGNOSIS AND TREATMENT OF CARDIORENAL FAILURE	EDITOR - Alison Brammah et al. report a case with successful treatment of acute cardiorenal failure after stenting of a 90% stenosis of the right renal artery (kidney size 9.5 cm). The left renal artery was occluded (left kidney size 7.0 cm) (1). We agree that the recognition of potentially curable renovascular disease as a cause of cardiorenal failure is important, and that stenting of high grade renal artery stenoses should be considered in patients with severe cardiac failure. In general, recanalisation of occluded renal arteries should also be discussed in this context if sufficient renal size is found (usually renal length above 8.0 cm is regarded sufficient if renal parenchyma is reasonably adequate). We have previously reported the near normalisation of serum creatinine after the successful recanalisation and stenting of bilateral high grade stenoses complicated with thrombosis and occlusion of the renal arteries in a patient with dialysis dependent acute anuric renal failure, hypertension and pulmonary edema (2). Recognizing the technical advances in invasive endovascular reconstruction and the potential great benefit in these high risk patients, the treatment spectrum in patients with cardiorenal failure caused by renovascular disease should therefore also include the possibility of revascularisation of occlusive arterial disease of up to several weeks duration. 1. Brammah A, Robertson S, Graeme T, Isles C. Bilateral renovascular disease causing cardiorenal failure. Br Med J 2003; 326: 489-491. 2. Svarstad E, Hultstrøm D, Jensen D, Jenssen G, Iversen BM. Renal artery thrombosis with acute renal failure after withdrawal of angiotensin converting enzyme inhibitor: a case report. Nephrol Dial Transplant 2002: 17: 687-689. Einar Svarstad, consultant nephrologist Einar.svarstad@helse-bergen.no Bjarne M. Iversen, professor Bjarne.iversen@med.uib.no Renal Unit, Haukeland University Hospital Competing interests:   None declared