Papel da nefrectomia do rim atrófico nos portadores de hipertensão renovascular

Abstract

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