From the Research
Ligating the renal vein would significantly decrease or completely stop urine output from the affected kidney, and this effect is supported by the most recent and highest quality study available 1. When the renal vein is ligated, blood cannot exit the kidney, causing severe congestion and increased hydrostatic pressure within the organ. This elevated pressure impairs glomerular filtration, as the pressure gradient necessary for filtration is disrupted. The kidney becomes engorged with blood, leading to tissue hypoxia, cellular damage, and eventually necrosis if the ligation persists. Unlike renal artery ligation (which stops blood flow into the kidney), renal vein ligation allows blood to enter but not leave, creating a more damaging congested state. This vascular compromise triggers inflammatory responses and coagulation cascades that further damage kidney tissue.
In clinical settings, renal vein obstruction is a medical emergency requiring immediate intervention to restore venous outflow and preserve kidney function. If both renal veins were ligated, or in a patient with a single kidney, complete anuria (absence of urine production) would result, leading to acute kidney injury and requiring urgent dialysis support. The study by 1 found that ligation of the left renal vein is associated with increased levels of acute kidney injury and renal deterioration in the early post-operative phase, although long-term renal function does not seem to be affected.
Some key points to consider include:
- The impact of renal vein ligation on kidney function and urine output is significant and should be considered in surgical planning and patient management.
- The use of left renal vein ligation during abdominal aortic aneurysm repair has been associated with increased risk of postoperative renal complications, as shown in studies such as 2.
- However, other studies like 3 suggest that left renal vein division and ligation may be safe in selected patients, with no significant long-term effects on renal function.
- A case report 4 also demonstrated the feasibility and safety of left renal vein ligation in a patient with a single left kidney undergoing liver transplantation, highlighting the importance of individualized patient management and careful consideration of the risks and benefits of such procedures.
Overall, the decision to ligate the renal vein should be made with caution and careful consideration of the potential risks and benefits, prioritizing the preservation of kidney function and urine output whenever possible.