Anuria and cold left leg

A 58-year-old man with sudden onset of anuria was admitted to hospital in January 2001. The patient had received a cadaver kidney transplant in 1987 for the treatment of end-stage renal failure caused by chronic glomerulonephritis. The allograft had been placed in the left iliac fossa with an end-to-side anastomosis between the renal artery and the common left iliac artery. The postoperative course was uneventful and standard immunosuppressive therapy was given. He had a history of myocardial revascularization and atherosclerotic disease of the lower limbs without intermittent claudication. On admission, physical examination was unremarkable except for bilateral loss of peripheral (femoral) pulses and pallor and marked decrease of the skin temperature of the left leg, without symptoms of complete arterial occlusion. Blood pressure was 160u90 mmHg, pulse rate was regular at 84 beats per minute and his body temperature was 36.88C. Laboratory studies on admission showed a slight impairment of renal function.