Permanent Hypertension after Renal Homotransplantation in Man

Abstract

1. In forty-one patients who underwent renal homotransplantation the following measurements were made: (a) blood flow and its distribution in the transplanted kidney as measured by the 85-Kr washout method; (b) renin release in the renal vein of the transplant; (c) arteriovenous difference in plasma renin activity (PRA) of the recipient's remaining left kidney. 2. Eleven transplanted patients were normotensive. Renal haemodynamic data were comparable with those obtained in potential kidney donors. 3. Three hypertensive patients had chronic rejection. The mean renal blood flow and the percentage flow in the first component of the washout curve were reduced. Renin release from the transplant, however, was normal. 4. Ten hypertensive patients had transplant artery stenosis. In eight of them renin release from the grafts as well as peripheral PRA were within normal range. This result is similar to experimental data obtained in Goldblatt renovascular hypertension. The two patients with the tightest artery stenosis had an elevated renin release from the transplant. 5. Thirteen hypertensive patients had elevated arteriovenous difference in PRA of the recipient's own left kidney. Peripheral PRA was significantly higher than in normotensive patients. Left nephrectomy relieved hypertension in ten of them; three have not so far undergone nephrectomy. 6. In four other cases hypertension was also relieved by removal of the patient's own kidney; however, the arteriovenous difference in PRA of that kidney fell within normal range.

Post-Transplant Hypertension and Hypertensive Encephalopathy in Renal Allograft Recipients

“…Cohen [28] reported that 17 of 22 non-nephrectomized patients were post-transplant hypertensive compared with 24 of 59 nephrectomized patients. Coles et al [13], Grunfeld et al [30], Sullivan et al [40], Papadimitriou et al [41] and Lee et al [42] have reported beneficial effects of removal of one or two diseased kidneys in patients with hypertension after successful renal transplantation. In some of these cases, there was no evidence of increased renin production from the native kidneys, and it is postulated that hyper tension may be due to the diseased kidneys producing a non-renin pressor substance.…”

“…15 patients had renal artery stenosis, but only 1 had hyper tension. Grunfeld et al [30] found 10 of their allograft recipients to have renal artery stenosis. Bachy et al…”

Influence of Familial Hypertension of the Donor on the Blood Pressure and Antihypertensive Therapy of Kidney Graft Recipients

“…Different causes for it have been pro posed : impairment of kidney function because of acute or chronic rejection [I]; the presence of the patient's own diseased kidneys [2][3][4]; steroid therapy [5], artd stenosis of the graft artery and hyperactivity of the renin-angiotensin system [3,[5][6][7][8][9], The prevalence of hypertension has been reported to range from 8 to 17% [10] during the first months and to rise to 50-85% [11,12] later.…”

Hypertension in Chronic Renal Failure

“…The most impressive report of this phenomenon was provided by Cohen [36] who noted a substantial increase in the prevalence of posttransplant hypertension (41-77%) following the re versal of a policy of routine pretransplant bilateral ne phrectomy at his institution [36]. Similar, but less dra matic reports of the value of bilateral nephrectomy have been provided by several other investigators [33,40,41], Rao et al [32] reported a much higher frequency of post transplant hypertension in 127 patients who were hyper tensive before transplantation (60%) than in a corre sponding group of 37 subjects who were normotensive prior to transplantation (13%) [32], This highly signifi- Values expressed as mean ± cant difference (x2 = 24.5, p < 0.001 ) emphasizes the role of the hosts own kidneys as a possible cause for posttrans plant hypertension. The role of corticosteroids in the gen esis or maintenance of hypertension following renal transplantation is controversial [31-34, 42, 43] but it seems unlikely that prednisone therapy plays any major role, at least in patients with stable renal function.…”