THE ROENTGENOGRAPHIC PRE AND POSTOPERATIVE ASSESSMENT OF PATIENTS WITH RENOVASCULAR DISEASE

1. The excretory urogram is valuable in prognosticating the results of corrective surgery for renovascular disease. A delay in calyceal opacification time and/or a definite difference in volume of excreted contrast material on the early (1 to 4 minute) films is the primary finding. No other finding, such as a significant difference in renal size, hyperconcentration, or pelvic or ureteral notching was found in any patients cured of renovascular hypertension, who did not have an early difference in calyceal opacification time or volume.

2. On serial postoperative excretory urograms of patients cured or markedly improved of renovascular hypertension by revascularization procedures, there was: (a) an initial increase in size of the operated kidney, which returned to the preoperative size over a period of years; (b) a gradual decrease in size of the nonoperated kidney; (c) a frequent difference in calyceal concentration in the immediate postoperative period, which became equal within 1 year; and (d) an immediate reversal of the signs of collateral blood flow (pelvic or ureteral notching).

3. In patients who had technically adequate operations for renal artery stenosis, but who remained hypertensive, there was little change in size or function of the operated or nonoperated kidney.

4. Technical failures of revascularization procedures usually develop in the early postoperative period.

5. There was no correlation in changes in size of the nonoperated kidney and cure or failure of the patient's hypertension following nephrectomy.

6. Progression of renal artery stenosis of the nonoperated kidney is unusual, except in children.

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