Surgery: More Blood for the Kidney

All the body’s vital organs depend for their efficient functioning on a generous supply of arterial blood, and all deteriorate when that supply is curtailed. Thus it seems logical for surgeons to try to cure or alleviate disease by restoring the blood flow. The validity of this approach has been proved in the case of the brain, and it may work when an artery is implanted into the wall of a failing heart. So why not do the same thing for a failing kidney?

Previous attempts to increase the kidney’s blood supply were ineffective, but Dr. Harry S. Goldsmith of Manhattan’s Sloan-Kettering Institute told the American College of Surgeons last week that he thinks his new method may be superior. The challenge to the surgeon is high blood pressure resulting from a partial shutdown of either or both renal (kidney) arteries. Estimates of the number of victims of this type of hypertension range as high as 1,000,000 in the U.S.

Although ingenious methods have been devised to increase the blood supply to the kidneys, Goldsmith said, the volume of the increase was too small to do much good. What he has done, so far only in dogs, is to make a bold attack “By removing the spleen, which both animals and man can live without, and implanting the splenic artery directly into the kidney. This delivers an enormously increased blood supply—enough to restore the kidney to normal function. In dogs that had been made hypertensive by reducing the blood supply to their kidneys, the blood pressure dropped to within the normal range soon after the artery implant.

“We are ready to begin trials on patients,” said Goldsmith. In addition to those with renal hypertension, candidates for the operation will include patients who have had part of a kidney removed for cancer. Successful arterial implants would reduce the demand for transplants. The next question is whether the technique might be used for patients who have had much of the liver removed because of cancer or injury.