Hypertension and renovascular disease: follow-up on 100 renal vein renin samplings

Hasbak, Philip; Jensen, Lars Thorbjørn; Ibsen, Hans

doi:10.1038/sj.jhh.1001365

Cited by 12 publications

(6 citation statements)

References 18 publications

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“…9 It is an invasive test done with angiographic sampling; a high renin gradient on the affected renal side coupled with a low gradient on the contralateral side is called lateralisation. In a review of 100 sampling cases, Hasbak et al 10 found poor predictive value of lateralisation. In parenchymal disease, the value of RVRR is undetermined.…”

Section: Discussionmentioning

confidence: 99%

Role of laparoscopic nephrectomy for refractory hypertension in poorly functioning kidneys

Elhage

Sahai

Challacombe

et al. 2011

annals

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Ann R Coll Surg Engl 2011; 93: 25-26 25Hypertension affects millions around the world.1 Effective treatment is multifaceted starting with life-style changes to combination drug therapy. The main aim is to achieve a reduction in blood pressure (BP) to below 140/90 mmHg (systolic/diastolic) in order to minimise the risk of target organ damage.2 Resistant hypertension is a challenge to clinicians. The risk of organ damage increases if BP is not controlled. In selected cases of renal disease, nephrectomy may allow adequate BP control in otherwise uncontrolled hypertension. The advancement of laparoscopic nephrectomy may lead to decreased morbidity and faster recovery in these patients. Patients and MethodsAll patients referred to us had been treated for hypertension for more than 5 years. The indication for nephrectomy was uncontrolled hypertension despite long-term medical treatment, recurrent renal pain, pyelonephritis or poorly functioning kidneys. Antihypertensive medications in these patients included bendrofluazide atenolol, labetelol, indapamide, perindopril, captopril and ramipril. Pre-operatively, patients had renal ultrasound, serum creatinine, urea and full blood count assessments. Patients had functional renograms to confirm the presence of a poorly functioning kidney (< 10% of split function). They underwent laparoscopic retroperitoneal nephrectomy under general anaesthetic using a standard 3-port technique. Balloon dilatation of the retroperitoneal space was performed using a visual balloon dilating trocar (balloon inflated to 500 ml). CO 2 insufflation was commenced. The Gerota's fascia was opened and the renal vessels identified, clipped and cut. The kidney was carefully dissected free and removed through the extended middle camera port. 4A total of 12 patients (7 females, 5 males) underwent laparoscopic retroperitoneal nephrectomy between 2002 and 2006. The mean age was 41 years (range, 30-65 years). The pre-operative blood pressure was 165 ± 35 mmHg systolic and 102 ± 29 mmHg diastolic (mean ± SEM). Mean serum creatinine preoperatively was 110 µmol/l (range, 53-125 µmol/l). Pre-operatively, five patients were on two antihypertensives, six were on one antihypertensive, and one was on four antihypertensive medications. Patients were followed up for a mean of 4.2 years (range, 2-6 years). ResultsThe mean blood loss was 75 ml (range, 25-250 ml), mean operative time 112 min (range, 70-400 min) and mean hospital-stay 2.5 days (range, 2-4 days). The mean time for full recovery was 3 weeks (range, 2-6 weeks). Mean creatinine postoperatively was 113 µmol/l (range, 54-120 µmol/l). Persistent hypertension can be difficult to manage and have detrimental effect on vital organs. Nephrectomy of poorly functioning kidneys may be indicated in a minority of such cases. PATIENTS AND METHODS We performed laparoscopic nephrectomy on 12 patients with refractory hypertension. RESULTS Eight had complete response, three had partial response and one had no response. CONCLUSIONS Laparoscopic nephrectomy has a role in carefu...

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Section: Discussionmentioning

confidence: 99%

Role of laparoscopic nephrectomy for refractory hypertension in poorly functioning kidneys

Elhage

Sahai

Challacombe

et al. 2011

annals

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“…Furthermore, renin samples were obtained up to 60 min after oral captopril administration, which is substantially later than the peak renin rise, which might have decreased the accuracy of the test [11,36]. In a series using furosemide as a renin-stimulating agent, no indices of lateralization were found to be predictive of treatment benefit [7]. Other studies with variable protocols and inclusion criteria also failed to show that RVRs are useful in predicting revascularization response [40,41].…”

Section: Discussionmentioning

confidence: 99%

“…Renal venous renin studies (RVRs) rely on the assumption that renin production should be higher on the side of the RAS than contralaterally and that lateralization of renin secretion should predict clinical benefit from revascularization in terms of BP lowering. To date, results have been conflicting as to the usefulness of RVRs, which have appeared to better differentiate patients who might benefit from nephrectomy rather than those who benefit from angioplasty [7,8]. However, the clinical protocols for RVRs have varied widely among these studies, including the degree to which factors (such as medications, dietary salt intake and posture) that affect renin levels are regulated, and whether samples are collected following stimulation of renin release by administration of an angiotensin-converting enzyme inhibitor (which has been shown to improve sensitivity of RVRs in detecting unilateral renin hypersecretion) [7][8][9][10][11].…”

Section: Introductionmentioning

confidence: 99%

The utility of renal venous renin studies in selection of patients with renal artery stenosis for angioplasty

Goupil¹,

Cowley

Wolley

et al. 2015

Journal of Hypertension

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“…Não encontramos lateralização da renina como fator preditor de resultados, dados semelhantes são descritos por Hasbak e cols. (56) . Os fatores que explicariam a ausência da lateralização da renina seriam a presença de estenose bilateral da artéria renal, estados depleção volêmica, uso crônico de inibidores de enzima de conversão de angiotensina I para II (IECA) e insuficiência renal.…”

Section: Discussionunclassified

Papel da nefrectomia do rim atrófico nos portadores de hipertensão renovascular

Thomaz¹

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Objective: to evaluate the beneficial effects of the Nephrectomy of atrophic kidney in patients with renovascular hypertension, on blood pression control and renal function. Methods: retrospective and observational study using database of 51 patients with refractory hypertension, atrophic kidney with significant stenosis or complete occlusion of renal artery undergone nephrectomy, between 1989 to 2005.The mean age of 47 ± 15 years (range 13-77 years), the median of serum creatinine level pre-op was 1.3 mg/dl (0.8-4.5 mg/dl), the median of clearence of creatinine was estimated with MDRD was 54ml/min, the mean systolic blood pressure (BP) pre-op was 149,6± 22,5 mmhg and the mean diastolic BP pre-op was 90,8± 16,7 mmhg with mean 2,8± 1 of antihypertensive medication per day. The blood pressure and serum creatinine were analyzed each year for five years after nephrectomy. Results: The operative mortality was 2%, we found significant decrease of the mean systolic BP from 12 month until 36 month (p≤0,028) and the mean diastolic BP from 12 month until 48 month after nephrectomy (p≤0,045), associated to significant decrease of antihypertensive medication from 12 month to 48 month per patient (p≤0, 05).One year after the procedure, there was decrease of blood pressure in 69% of patients and improve of renal function in 64% of patients. Eight per cent who had worse of renal function after 12 month, recovery the function during the observation period of 60 month. There were no significant differences between "respondedores" (good response) and "não respondedores (bad response)" after the nephrectomy of the atrophic kidney when we have analyzed age (p=0,89), sex (=0,24), color (p=0,50), co-mobility and risk factors (p≥0,43), level of initial BP, previous serum creatinine (p≥0,90) and the existence of bilateral stenosis (p≥0,74). Eight per cent of patients had end stage of renal disease (ESRD) and dialysis treatment during the study period, all of them with atherosclerotic lesion of renal artery and initial clearence of creatinine less them 25 ml/min. Those patients with fibromuscular dysplasia had better results on the control of BP and renal function them atherosclerotic patients. Conclusion: The take off atrophic kidney caused by obstruction of renal artery is a safe procedure and brings benefits to blood pressure and preserve the renal function, in patients with renovascular hypertension, with better results in those patients with fbromuscular dysplasia Descriptors: 1-Kidney 2-Atrophy 3-Renovascular hypertension 4-Nephrectomy

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Hypertension and renovascular disease: follow-up on 100 renal vein renin samplings

Cited by 12 publications

References 18 publications

Role of laparoscopic nephrectomy for refractory hypertension in poorly functioning kidneys

Role of laparoscopic nephrectomy for refractory hypertension in poorly functioning kidneys

The utility of renal venous renin studies in selection of patients with renal artery stenosis for angioplasty

Papel da nefrectomia do rim atrófico nos portadores de hipertensão renovascular

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