Changes of arterial pressure following relief of obstruction in adults with hydronephrosis

Abstract

Background: As much as 20% of all cases of hypertension are associated with kidney malfunctions. We have previously demonstrated in animals and in pediatric patients that hydronephrosis causes hypertension, which was attenuated by surgical relief of the ureteropelvic junction (UPJ) obstruction. This retrospective cohort study aimed to investigate: (1) the proposed link between hydronephrosis, due to UPJ obstruction, and elevated arterial pressure in adults; and (2) if elevated blood pressure in patients with hydronephrosis might be another indication for surgery.Materials and methods: Medical records of 212 patients undergoing surgical management of hydronephrosis, due to UPJ obstruction, between 2000 and 2016 were assessed. After excluding patients with confounding conditions and treatments, paired arterial pressures (i.e. before/after surgery) were compared in 49 patients (35 years old; 95% CI 29–39). Split renal function was evaluated by using mercaptoacetyltriglycine (MAG3) renography before surgical management of the hydronephrotic kidney.Results: Systolic (−11 mmHg; 95% CI 6–15 mmHg), diastolic (−8 mmHg; 95% CI 4–11 mmHg), and mean arterial (-9 mmHg; 95% CI 6–12) pressures were significantly reduced after relief of the obstruction (p < 0.001). Split renal function of the hydronephrotic kidney was 39% (95% CI 37–41). No correlations were found between MAG3 and blood pressure level before surgery or between MAG3 and the reduction of blood pressure after surgical management of the UPJ obstruction.Conclusions: In adults with hydronephrosis, blood pressure was reduced following relief of the obstruction. Our findings suggest that elevated arterial pressure should be taken into account as an indication to surgically correct hydronephrosis.

Surgical intervention and long-term renal outcomes of congenital ureteropelvic junction obstruction in a young adult cohort

“…In our adult study, there was no signi cant difference in the prevalence of de ned HTN pre-and post-intervention. In contrast, a retrospective analysis of 49 adults with congenital UPJO (not on antihypertensive medications) showed improvement in both systolic and diastolic BP after surgical intervention; however, these ndings were based predominantly on data ≤ 12 months after relief of obstruction 13 . For our non-intervention group, there were no signi cant differences between the initial and follow-up measures of de ned HTN and median BP.…”

Symptomatology and Clinic of Hydronephrosis Associated With Uretero Pelvic Junction Anomalies

“…It has been demonstrated that the function of the hydronephrotic kidney is rather well-preserved in young children, therefore it appears that the intrarenal mechanism leading to hypertension is also reversible (6,11). The clinical importance of such finding is that surgical management may prevent the development of chronic hypertension and associated comorbidities in patients with severe hydronephrosis (68)(69)(70). The pediatric urologist and nephrologist may have to pay more attention to the risk of development of high blood pressure in patients with severe hydronephrosis (Figure 2).…”