Reconstructive surgery versus nephrectomy in renal artery stenosis: comparison of effects on total and divided renal function and on blood pressure.

Twenty-six hypertensive patients with unilateral renal artery disease and normal overall renal function were treated surgically: eleven underwent arterial reconstruction and 15 unilateral nephrectomy. One year after operation there was similar reduction in blood pressure in each group (delta mean BP 45:3 mm Hg (p < 0.001) and 36.8 mm Hg (p < 0.001) respectively. contrary to previous reports, however, a small but significant improvement in overall renal function was observed in patients who underwent reconstructive surgery (delta mean serum creatinine--13.3 mumol/1 (p < 0.01); this was associated with a significant rise in para-aminohippurate (PAH) clearance in the operated kidney, while PAH clearance fell on the contralateral side. Overall renal function deteriorated in the patients who underwent unilateral nephrectomy (delta mean serum creatinine +22.7 mumol/1 (p < 0.01)). The latter was due partly to diminished clearance in the remaining kidney and partly to the loss of the excised kidney. The findings emphasise the superiority of renal artery reconstruction over nephrectomy in patients with renovascular hypertension.