Unilateral Parenchymatous Kidney Disease and Hypertension: Results of Nephrectomy and Medical Treatment

Abstract

In the present study 43 patients with unilateral parenchymatous kidney disease and hypertension were investigated. 20 patients were nephrectomized, 23 treated with antihypertensive drugs. Both therapeutic approaches showed an excellent and sustained blood pressure-(BP)-lowering effect. BP fell from 185 ± 27/116 ± 13 to 138 ± 20/86 ± 10 mm Hg in the operated and from 194 ± 32/116 ± 13 to 149 ± 22/95 ± 12 mm Hg in the medically treated patients after 2 and 6 weeks, respectively (p < 0.001). BP was 142 ± 16/89 ± 11 and 136+ 16/90 ± 10 mm Hg at the long-term follow-up in the 2 subgroups. In the operated group 70% (n = 14) were cured, 20% (n = 4) were improved and 10% (n = 2) unimproved. In the medically treated group 65% (n = 15) were normotensive, 26% (n = 6) improved and 9% (n = 2) treatment resistant. No significant correlation between postoperative BP reduction and lateralization of renin secretion (PRA-ratio > 1.5) was found. Although cured patients showed a higher mean PRA-ratio, 4 patients with a PRA-ratio < 1.5 were cured (n = 2) or improved (n = 2) postoperatively. Our results document an excellent and sustained antihypertensive effect of both nephrectomy and medical treatment in patients with unilateral parenchymatous kidney disease and hypertension. They further limit the predictive value of renal venous renin determination in the preoperative workup.

Curable Renal Parenchymatous Hypertension: Current Diagnosis and Management

“…Chronic pyelonephritis is by far the most common cause of unilateral nonvascu lar small kidneys in hypertensive patients [ 1 ]. A history of recurrent urinary tract infections may or may not be present.…”

“…It has therefore been argued whether these changes are the result of chronic pyelonephri tis or represent a congenital malformation [10]. Hypertension has been reported in the majority of these patients [1,9,[11][12][13][14]. In contrast to adult series where chronic pyelone phritis dominates, segmental hypoplasia is the Fig.…”

“…If the glomerular filtration rate drops below 50 ml/min, the incidence of hyperten sion rises and when dialysis is required, hy pertension is almost always present [16]. In contrast, most patients with unilateral paren chymatous renal hypertension have normal or near normal plasma creatinine values [1], The pathophysiology of hypertension there fore is different. In chronic pyelonephritis, hypertension is related to the presence of renal scars and vascular lesions [17], Renal ischemia and in turn activation of the renin angiotensin aldosterone system therefore seems to be a major factor in the pathogene sis of hypertension in these patients.…”

“…In fact, renal renin oversecretion of the involved kid ney is seen in most patients when the renin secretion index is used ( fig. 2) [1]. Still, the etiology of high blood pressure remains un clear in a minority of such patients with sym metrical renin secretion and a successful sur gical outcome.…”

“…In a subgroup of these patients however, the le sion may be strictly unilateral. Some of these patients may be candidates for nephrectomy, since cure of hypertension after the invervention has been well documented in a consider able number [1,2]. Normal blood pressure after reconstructive or ablative surgery has also been reported in patients with unilateral hydronephrosis, simple renal cysts, traumatic kidney lesions and renal tumors with hyper tension [3][4][5][6].…”