Increased use of antihypertensive medications after partial nephrectomy vs. radical nephrectomy

Hutchinson, Ryan; Singla, Nirmish; Krabbe, Laura Maria; Woldu, Solomon L.; Chen, Gong; Rew, Charles; Tachibana, Isamu; Lotan, Yair; Cadeddu, Jeffrey A.; Margulis, Vitaly

doi:10.1016/j.urolonc.2017.06.057

Cited by 6 publications

(5 citation statements)

References 18 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…[19] noted minor changes in BP but a significant increase in the use of antihypertensive drugs after surgery. Other authors reported an increased risk of HTN after PN compared to RN [16,17].…”

Section: Discussionmentioning

confidence: 99%

“…The scientific literature concerning variations in BP after renal surgery is sparse, contradictory and limited by a poor level of evidence (only retrospective cohort descriptions), absence of precise monitoring of BP, and lack of data concerning the use of antihypertensive therapy [15][16][17][18][19]. In the largest retrospective study (292 patients), Gupta et al [19] noted minor changes in BP but a significant increase in the use of antihypertensive drugs after surgery.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Nephrectomy for kidney tumour increases the risk of de novo arterial hypertension

et al. 2023

View full text Add to dashboard Cite

ObjectiveTo evaluate prospectively the effects of surgical excision of renal tumours on blood pressure (BP).Patients and MethodsIn a multicentre prospective study, we evaluated 200 patients who underwent nephrectomy for renal tumour between 2018 and 2020 at seven departments of the French Network for Kidney Cancer, the UroCCR. All patients had localized cancer without pre‐existing hypertension (HTN). Blood pressure was measured the week before nephrectomy, and at 1 month and 6 months after nephrectomy, according to the recommendations for home BP monitoring. Plasma renin was measured 1 week before surgery and 6 months after surgery. The primary endpoint was the occurrence of de novo HTN. The secondary endpoint was clinically significant increase in BP at 6 months, defined by an increase in systolic and/or diastolic ambulatory BP ≥10 mmHg or requirement for medical antihypertensive treatment.ResultsBlood pressure and renin measurements were available for 182 (91%) and 136 patients (68%), respectively. We excluded from the analysis 18 patients who had undeclared HTN detected on preoperative measurements. At 6 months, 31 patients (19.2%) had de novo HTN and 43 patients (26.3%) had a significant increase in their BP. Type of surgery was not associated with an increased risk of HTN (21.7% partial nephrectomy [PN] vs 15.7% radical nephrectomy [RN]; P = 0.59). There was no difference between plasmatic renin levels before and after surgery (18.5 vs 16; P = 0.46). In multivariable analysis, age (odds ratio [OR] 1.07, 95% confidence interval [CI] 1.02–1.12; P = 0.03) and body mass index (OR 1.14, 95% CI 1.03–1.26; P = 0.01) were the only predictors of de novo HTN.ConclusionSurgical treatment of renal tumours is associated with significant changes in BP, with de novo HTN occurring in almost 20% of the patients. These changes are not impacted by the type of surgery (PN vs RN). Patients who are scheduled to undergo kidney cancer surgery should be informed of these findings and have their BP closely monitored after the operation.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Nephrectomy for kidney tumour increases the risk of de novo arterial hypertension

et al. 2023

View full text Add to dashboard Cite

show abstract

“…Conversely, Inoue et al reported a progression of BP with PN as compared with radical nephrectomy [ 12 ]. Hutchinson et al found PN independently associated with increased number of antihypertension medications [ 13 ]. Some case reports have indicated that PN may precipitate postoperative hypertension due to complications or “Page kidney” phenomenon [ 14 , 15 ].…”

Section: Discussionmentioning

confidence: 99%

Effect of extensive artery isolation during robotic-assisted partial nephrectomy on blood pressure of patients with poorly controlled hypertension: a preliminary study

Wang

Zhao

et al. 2022

Int Urol Nephrol

View full text Add to dashboard Cite

Purpose To investigate whether extensive renal artery isolation during robotic-assisted partial nephrectomy (RAPN) for renal cell carcinoma (RCC) affects blood pressure (BP) of patients with poorly controlled hypertension. Methods We included 60 patients diagnosed with poorly controlled hypertension who underwent RAPN by an experienced surgeon. The renal artery of the treated kidney was sufficiently isolated. Systolic BP (SBP), diastolic BP (DBP) and antihypertensive medication information were obtained at baseline and 3- and 6-month follow-up after surgery. Primary endpoints were changes in BP, and medications. Predictors of SBP reduction at 3 months were assessed by multivariable logistic regression. Results All 60 RAPN procedures were successful, with no major intra- or postoperative complications. Mean SBP and DBP decreased significantly at 3 months after surgery (SBP, −7.8 ± 6.3 mmHg, P < 0.001; DBP, −4.2 ± 6.4 mmHg, P = 0.01). SBP and DBP did not differ between 3- and 6-month follow-up. The mean number of BP medications prescribed was lower at 3 months than baseline (1.7 ± 1.0 vs 2.1 ± 1.0, P = 0.016). The only significant predictor of SBP reduction at 3 months was baseline SBP. Conclusions Renal denervation with extensive renal artery isolation during RAPN may improve BP control among patients with poorly controlled hypertension in short term.

show abstract

“…Tal associação, não relatada para CET, é controversa em outros cenários. Enquanto dois estudos reportaram associação entre nefrectomia parcial e progressão posterior para HAS (124), mesmo em relação a nefrectomia total (125), outro não encontrou tal associação (126) e um quarto revelou maior associação de HAS à nefrectomia radical (127). Ainda não foram completamente esclarecidos mecanismos que possam justificar tais dados aparentemente conflitantes.…”

Section: Discussionunclassified

“…Adicionalmente, procedimentos realizados na nefrectomia parcial, incluindo clampeamento do hilo renal, compressão da cápsula durante a renorrafia e oposição das extremidades cortadas dos vasos arteriais e venosos, apresentam potencial teórico de alterar parâmetros hemodinâmicos renais e contribuir para o desenvolvimento de HAS (125). Nossos achados trazem, portanto, dados adicionais de suporte à tendência atual de evitar a realização de nefrectomia em pacientes com AMLs múltiplos sempre que possível.…”

Section: Discussionunclassified

Caracterização clínico-radiológica e tratamento de angiomiolipomas múltiplos e/ou grandes com inibidor de mTOR: efeitos sobre os componentes vascular, adiposo e muscular e avaliação de risco associado a nef

Watanabe¹

View full text Add to dashboard Cite

Watanabe EH. Caracterização clínico-radiológica e tratamento de angiomiolipomas múltiplos e/ou grandes com inibidor de mTOR: efeitos sobre os componentes vascular, adiposo e muscular e avaliação de risco associado a nefrectomia e sangramento tumoral Angiomiolipomas renais (AMLs) são tumores complexos com componentes vascular, gorduroso e muscular. Apresentam prevalência relativamente elevada na população geral, ocorrendo geralmente na forma esporádica. Em cerca de 10% dos casos, entretanto, AMLs associam-se com o complexo esclerose tuberosa (CET). Nesta doença, tais tumores acometem a maior parte dos pacientes e são geralmente múltiplos, bilaterais e precoces. AMLs podem ainda se associar com linfagioleiomiomatose pulmonar esporádica (LAM) e, raramente, se manifestar como lesões múltiplas isoladas. Sua principal complicação é hemorragia, de caráter potencialmente grave. Por essa razão, intervenções invasivas eram até recentemente indicadas para AMLs com alto risco de sangramento. Esses procedimentos, entretanto, associam-se a risco de perda significativa de massa renal funcional. Inibidores de mTOR, por sua vez, apresentam um importante efeito redutor de volume sobre AMLs. Seus efeitos específicos sobre os diferentes componentes tumorais, entretanto, não são conhecidos. Nesse cenário, investigamos os efeitos do sirolimo sobre os diferentes compartimentos do AML, e especificamente sobre as formações aneurismáticas/ectásicas intratumorais. Também analisamos seu papel potencial como terapia neoadjuvante em pacientes com AMLs submetidos a nefrectomia com preservação de massa renal. Analisamos 147 pacientes com AMLs associados a CET, LAM e múltiplos isolados. Observamos índices elevados de hipertensão arterial, albuminúria e malignidade para a idade avaliada na população estudada. Também detectamos associação entre a realização de nefrectomia e menor taxa de filtração glomerular estimada. Nefrectomia total constituiu preditor independente para doença renal crônica estágio 3 ou acima, enquanto nefrectomia parcial foi identificada como preditor independente para ocorrência de hipertensão arterial. Tratamento com sirolimo reduziu o tamanho dos AMLs, efeito que não diferiu entre pacientes com CET, LAM ou AMLs múltiplos isolados. Pacientes pré-tratados com sirolimo e submetidos a nefrectomia apresentaram elevações menores de creatinina sérica que pacientes nefrectomizados não pré-tratados, 48h e 7 meses após o procedimento cirúrgico. Não foram observados eventos adversos graves relacionados a este pré-tratamento. A análise de 23 tumores de pacientes com CET tratados com sirolimo mostrou redução do volume tumoral, um efeito primariamente determinado pela diminuição dos compartimentos com baixo teor de gordura. De fato, baixo teor de gordura mostrou-se um preditor independente de redução de pelo menos 50% do volume de AMLs em resposta a sirolimo. Interessantemente, o volume do compartimento rico em gordura aumentou em resposta ao sirolimo. Nesse cenário, alguns AMLs pobres em gordura evoluíram com lipossubstituição. Observam...

show abstract

Increased use of antihypertensive medications after partial nephrectomy vs. radical nephrectomy

Cited by 6 publications

References 18 publications

Nephrectomy for kidney tumour increases the risk of de novo arterial hypertension

Nephrectomy for kidney tumour increases the risk of de novo arterial hypertension

Effect of extensive artery isolation during robotic-assisted partial nephrectomy on blood pressure of patients with poorly controlled hypertension: a preliminary study

Caracterização clínico-radiológica e tratamento de angiomiolipomas múltiplos e/ou grandes com inibidor de mTOR: efeitos sobre os componentes vascular, adiposo e muscular e avaliação de risco associado a nef

Contact Info

Product

Resources

About