Q: My 84 years old stepfather's aortic aneurysm progressed past 4.5 cm and was repaired by endovascular surgery last year. Post operation was typical and he left the hospital in 4 days. He has always been an athlete and continued to be well into his 70s. From the past six months, he had been experiencing extreme fatigue, increased urine output, debilitating nausea and vomiting on a daily basis. He also has high blood pressure. He underwent several tests and it was found that one of his kidneys was badly damaged. It was suspected a graft might have collapsed the artery supplying the blood to kidneys. He is taking Lisinopril 10 mg per day. Now, he is hospitalised to check the condition of the grafts, which were found in good order. The surgeon said that his kidney was totally damaged and that it would not be necessary to remove the kidney. We are trying to understand how his kidney got damaged suddenly and why it wouldn't be removed?

A:It would be difficult to comment on the case without having complete information concerning the blood report (serum creatinine level), urine tests and kidney imaging results. Post-operative development of kidney failure could happen secondary to either the usage of certain contrast dye (known to be kidney toxic at times) during the surgery, certain types of medications including antibiotics potentially kidney toxic or rarely from the blockage of kidney arteries supplying the blood to the concerned kidney (either sides or rarely both) as a result of a dislodgement of an atheroembolus happening during the surgical repair of the concerned aneurysm. The last mentioned cause can present more than 6-8 weeks following the surgery as in the above case. It would be obvious by gradual worsening of renal function resulting in symptoms of uremia including nausea and vomiting (occurring due to accumulation of waste products in the blood). Lastly, kidney removal (called nephrectomy) is not indicated for a complete nonfunctioning kidney unless the kidney remains severely infected on a recurrent basis in spite of antibiotic treatment.