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CardioVascular and Interventional Radiology

, Volume 27, Issue 3, pp 204–207 | Cite as

Renal Artery Embolization - A First Line Treatment Option For End-Stage Hydronephrosis

  • Kakali Mitra
  • Vikramaditya Prabhudesai
  • R. Lester James
  • Robert W. A. Jones
  • Michael E. French
  • Mark Cowling
  • David J. West
Article

Abstract

Conventionally poorly functioning hydronephrotic kidneys have been removed if they are symptomatic. In our unit, patients are offered renal artery embolization as an alternative treatment option. Patients and Methods: Fifteen patients (11 male, 4 female) with a mean age of 32.9 yr (20–51 yrs) have undergone renal artery embolization for symptomatic hydronephrosis with poor function. Mean follow-up was 64.13 weeks (range 14–200). All patients had loin pain and hydronephrosis. Twelve patients had primary pelvi-ureteric junction obstruction (PUJO). Two patients had poorly functioning hydronephrotic kidneys secondary to chronic calculous obstruction. One patient had chronic pain in an obstructed but reasonably functioning kidney following a previous pyeloplasty for PUJO which demanded intervention. Mean split function on renography was 11% (range 0–46%). Selective renal artery embolization was carried out under antibiotic cover using a 7 Fr balloon occlusion catheter and absolute alcohol, steel coils, and polyvinyl alcohol particles.Results: Nine patients developed post-embolization syndrome of self-limiting pain and pyrexia with no evidence of sepsis. One patient required readmission with this condition. One patient developed a hematoma at the puncture site. Mean hospital stay was 2.3 days. Fourteen patients are happy with the result and are completely pain free. One patient has minor discomfort but is delighted with the result. Nine patients have had follow-up ultrasound confirming resolution of the hydronephrosis. Conclusion: Renal artery embolization is an effective, safe, well-tolerated minimally invasive treatment option in end-stage hydronephrosis and we routinely offer it as an alternative to nephrectomy.

Keywords

Renal artery embolization Pelvi-ureteric junction Hydronephrosis 

References

  1. 1.
    Lumerman, JH, Smith, AD 1997Complete and partial renal infarction.AUA Update Series, lesson 16.p186Google Scholar
  2. 2.
    Makita, Y, Hori, K, Osato, S,  et al. 1989Successful treatment of massive hemorrhage after percutaneous renal biopsy with transcatheter arterial embolization.Am J Nephrol9(6)513515Google Scholar
  3. 3.
    Farmer, CD, Diaz-Buxo, JA, Grubb, WL, Chandler, JT, Walker, PJ 1981Control of post renal biopsy hemorrhage by Gelfoam embolization.Nephron28(3)149151Google Scholar
  4. 4.
    Cowan, NC, Traill, ZC, Phillips, AJ, Gleeson, FV 1998Direct percutaneous transrenal embolization for renal artery injury following percutaneous nephrostomy.Br J Radiol71(851)11991201Google Scholar
  5. 5.
    Heyns, CF, van Vollenhoven, P 1992Increasing role of angiography and segmental artery embolisation in the management of renal stab wounds.J Urol147(5)12311234Google Scholar
  6. 6.
    Khan, AB, Reid, AW 1994Management of renal stab wounds by arteriographic embolisation.Scand J Urol Nephrol28(1)109110Google Scholar
  7. 7.
    Takebayashi, S, Hosaka, M, Kubota, Y, Ishizuka, E, Iwasaki, A, Matsubara, S 1998Transarterial embolization and ablation of renal arteriovenous malformations: efficacy and damages in 30 patients with long-term follow-up.J Urol159(3)696701CrossRefGoogle Scholar
  8. 8.
    Oesterling, JE, Fishman, EK, Goldman, SM, Marshall, FF 1986The management of renal angiomyolipoma.J Urol13511211124Google Scholar
  9. 9.
    Kehagias, D, Mourikis, D, Kousaris, M, Chatziioannou, A, Vlahos, L 1998Management of renal angiomyolipoma by selective arterial embolization.Urol Int60(2)113117Google Scholar
  10. 10.
    Kalman, D, Varenhorst, E 1999The role of arterial embolization in renal cell carcinoma.Scand J Urol Nephrol33(3)162170Google Scholar
  11. 11.
    De Baere, T, Lagrange, C, Kuoch, V, Morice, P, Court, B, Roche, A 2000Transcatheter ethanol renal ablation in 20 patients with persistent urine leaks: An alternative to surgical nephrectomy.J Urol164(4)11481152CrossRefGoogle Scholar
  12. 12.
    Shimmura, H, Ishikawa, N, Tanabe, K,  et al. 1998Angiographic embolization in patients with renal allograft arteriovenous fistula.Transplant Proc30(7)29902992CrossRefGoogle Scholar
  13. 13.
    Gonzalaz-Satue, C, Riera, L, Franco, E, Escalante, E, Dominguez, J, Serrallach, N 2000Percutaneous embolization of the failed renal allograft in patients with graft intolerance syndrome.Br J Urol86610612Google Scholar
  14. 14.
    Keller, FS, Coyle, M, Rosch, J, Dotter, CT 1986Percutaneous renal ablation in patients with end-stage renal disease: alternative to surgical nephrectomy.Radiology159(2)447451Google Scholar
  15. 15.
    Aytekin, C, Yologlu, Z, Boyvat, F, Moray, G, Ataman, A, Haberal, M 1999Renal ablation with alcohol for proteinuria in patients with end-stage renal disease: Alternative to surgical nephrectomy.Transplant Proc31(8)31403141CrossRefGoogle Scholar
  16. 16.
    Golwyn Jr, DH, Routh, WD, Chen, MY, Lorentz, WB, Dyer, RB 1997Percutaneous transcatheter renal ablation with absolute ethanol for uncontrolled hypertension or nephrotic syndrome: Results in 11 patients with end-stage renal disease.J Vasc Inter Radiol8(4)527533Google Scholar
  17. 17.
    Klimberg, IW, Locke, DR, Hawkins Jr, IF, Drylie, DM 1989Absolute ethanol renal angioinfarction for control of hypertension.Urology33(2)153158CrossRefGoogle Scholar
  18. 18.
    Olivero, JJ, Frommer, JP, Gonzalez, JM 1993Medical nephrectomy: The last resort for intractable complications of the nephrotic syndrome.Am J Kid Dis21(3)260263Google Scholar
  19. 19.
    Sorrentino, F, Ziviello, M, Camocardi, S, Marinelli, V 1981Therapeutic embolization of polycystic kidneys.Int Urol Nephrol13(1)3540Google Scholar
  20. 20.
    Hahn, ST, Park, SH, Lee, JM, Kim, CY, Chang, YS 1999Renal artery embolization controls intractable pain in a patient with polycystic kidney disease.Cardiovasc Int Radiol22(5)422424CrossRefGoogle Scholar
  21. 21.
    Ubara, Y, Katori, H, Tagami, T,  et al. 1999Transcatheter renal arterial embolization therapy on a patient with polycystic kidney disease on hemodialysis.Am J Kid Dis34(5)926931Google Scholar
  22. 22.
    Pezzulli, FA, Purnell, FM, Dillon, EH 1989Post-traumatic unilateral hydronephrosis with hypertension treated by embolization.Urology33(1)7073CrossRefGoogle Scholar
  23. 23.
    Gawne-Cain, ML, Reidy, JF, Flannery, J 1993Case report: Transcatheter renal embolization to effect renal ablation in recurrent PUJ obstruction in a patient with haemophilia.Clin Radiol48(6)429430Google Scholar
  24. 24.
    Hirao, Y, Okajima, E, Yoshida, K,  et al. 1993Renal ablation with absolute ethanol for non- functioning hydronephrosis.Eur Urol24(2)203207Google Scholar
  25. 25.
    Hom, D, Eiley, D, Lumerman, JH, Siegel, DN, Goldfischer, ER, Smith, AD 1999Complete renal embolisation as an alternative to nephrectomy.J Urol1612427Google Scholar
  26. 26.
    Milewski, JB, Malewski, AW, Malanowska, S,  et al. 1981Spinal cord damage as a complication of renal artery embolization in patients with renal carcinoma.Int Urol Nephrol13(3)221229Google Scholar
  27. 27.
    Gang, DL, Dole, KB, Adelman, LS 1977Spinal cord infarction following therapeutic renal artery embolisation.JAMA2372481Google Scholar
  28. 28.
    Cox, GG, Lee, KR, Price, HI, Gunter, K, Nobel, M, Mebust, WK 1982Colonic infarction following ethanol embolisation of renal cell carcinoma.Radiology145343PubMedGoogle Scholar
  29. 29.
    Toussi, H, McConnell, ., Srinivasan, V 2001Renal artery embolisation for benign obstructive uropathy.J Urol16511621163Google Scholar

Copyright information

© Springer-Verlag New York, Inc. 2004

Authors and Affiliations

  • Kakali Mitra
    • 1
  • Vikramaditya Prabhudesai
    • 1
  • R. Lester James
    • 2
  • Robert W. A. Jones
    • 1
  • Michael E. French
    • 1
  • Mark Cowling
    • 1
  • David J. West
    • 1
  1. 1.University Hospital of North Staffordshire NHS TrustNewcastle under Lyme ST4 6QG UK
  2. 2.Staffordshire General HospitalStafford ST16 S5AUK

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