Effects of Partial Nephrectomy on Postoperative Blood Pressure

Abstract

PurposeThe effects of partial nephrectomy (PN) on postoperative blood pressure (BP) are not known, and PN has the potential to worsen BP. We therefore sought to determine whether PN alters postoperative BP.Materials and MethodsPatients who underwent PN for suspected malignancy at our institution from 2002 to 2008 were included. Data on BP and medication from before and after PN were retrieved from family physicians. BP and number of antihypertensive medications were compared after surgery with preoperative values by use of paired t tests and Chi-squared analyses, respectively.ResultsOf 74 patients undergoing PN and providing consent, 48 met the inclusion and exclusion criteria, with a median follow-up of 24 months. For the early postoperative period (1 month to 1 year after surgery), the mean BPs (132.3/77.0 mmHg) were unchanged compared with preoperative values (132.4/78.0 mmHg; p=0.59 systolic BP and p=0.30 diastolic BP). For the later postoperative period (beyond 1 year after surgery), the mean postoperative systolic BP was unchanged from the mean preoperative systolic BP (131.2 mmHg vs. 132.4 mmHg, respectively; p>0.30). However, the corresponding average diastolic BP was lower in the long term (78.0 mmHg versus 76.4 mmHg respectively; p=0.01). No significant difference in the mean number of BP medications prescribed preoperatively, at one year, and beyond one year was identified (p>0.37).ConclusionsPN does not result in initial or long-term postoperative deterioration in BP.

Risk Factors for the Comorbidity of Hypertension and Renal Cell Carcinoma in the Cardio-Oncologic Era and Treatment for Tumor-Induced Hypertension

“…Considering that partial nephrectomy (PN) can better preserve kidney function than radical nephrectomy (RN), PN is recommended to treat patients with early stage tumors ( 3 ). Nephrectomy-related HTN (NR-HT) has been reported by several studies, but robust high-level evidence is still needed ( 8 , 67 – 69 ). The use of targeted therapies, especially vascular endothelial growth factor signaling pathway (VSP) inhibitors, has remarkably increase the life expectancy of patients with mRCC while the increased risk of cardiovascular events turns out to be its obvious side effect ( 5 , 70 ).…”

“…In addition, vascular clamping in PN process could cause vasculitis and intimal hyperplasia, which would aggravate renal artery stenosis, resulting in the decline of glomerular capillary pressure and activated rennin-angiotensin system, leading to NR-HT ( 72 ). However, some studies drew opposite conclusions ( 67 , 73 ). A retrospective study involving 264 patients with PN showed that BP had no significant change after surgery ( 67 ).…”

“…However, some studies drew opposite conclusions ( 67 , 73 ). A retrospective study involving 264 patients with PN showed that BP had no significant change after surgery ( 67 ). A plausible explanation is that PN may treat paraneoplastic HTN, which can mask NR-HT, thus resulting in a statistically insignificant difference.…”

Can Renal Denervation during Nephron Sparing Surgery for Renal Cell Carcinoma Prevent De Novo Hypertension Occurrence and Potentially Confer a Survival Benefit?

“…Hypothetically, reduced blood flow and glomerular pressure in the partially resected kidney could cause renin release, ensuring the Goldblatt model of hypertension persists [35]. Several sporadic reports have indicated that PN [36,37] or nephrolithotomy [38] may precipitate postoperative hypertension and renal injury due to trauma can lead to postoperative hypertension in the form of "Page kidney" after repair [35].…”

“…Hypothetically, reduced blood flow and glomerular pressure in the partially resected kidney could cause renin release, ensuring the Goldblatt model of hypertension persists [35]. Several sporadic reports have indicated that PN [36,37] or nephrolithotomy [38] may precipitate postoperative hypertension and renal injury due to trauma can lead to postoperative hypertension in the form of "Page kidney" after repair [35]. Lawrentschuk and colleagues (2012) claimed that PN does not cause postoperative hypertension in 48 patients undergoing PN over 2 years [35], while Inoue and colleagues showed that hypertension progressed after PN (79 patients) compared with nephrectomy (24 patients) over 9 months [39].…”