447 NEPHRECTOMY FOR HYPERTENSION IN PEDIATRIC PATIENTS WITH UNILATERAL RENAL PARENCHYMAL DISEASE: A CONTEMPORARY COHORT

Abstract

You have accessJournal of UrologyPediatrics: Congenital Anomalies - Kidney & Ureter1 Apr 2010447 NEPHRECTOMY FOR HYPERTENSION IN PEDIATRIC PATIENTS WITH UNILATERAL RENAL PARENCHYMAL DISEASE: A CONTEMPORARY COHORT Bruce Schlomer, Paul Smith, Theodore Barber, Warren Snodgrass, and Linda Baker Bruce SchlomerBruce Schlomer More articles by this author , Paul SmithPaul Smith More articles by this author , Theodore BarberTheodore Barber More articles by this author , Warren SnodgrassWarren Snodgrass More articles by this author , and Linda BakerLinda Baker More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.519AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES A unilateral poorly functioning or non-functioning kidney is a known cause of hypertension in children. Few small pediatric series have reported on the success of nephrectomy for treating hypertension in these patients, with resolution of hypertension in 50-76%. To expand this experience, we analyzed outcomes of nephrectomy for pediatric patients with hypertension and unilateral renal disease in a contemporary cohort. METHODS This is a retrospective single institution review of consecutive hypertensive patients with unilateral renal parenchymal disease who underwent nephrectomy. Preoperative characteristics such as blood pressure, medications, laboratory values, renal imaging, time of diagnosis, age, and cause of renal disease were tabulated as were postoperative data including blood pressure, medications, complications, laboratory values, and time to normalization of blood pressure. RESULTS Out of 159 nephrectomies from July 2002 to August 2009, 21 met inclusion criteria with follow-up blood pressure measurements. The average age of the patients was 3.5 yrs (range 2.1 mo – 11.8 yrs) and average follow up was 17.8 months (range 1 – 36 months). There were 11 patients with multicystic dysplastic kidney, 9 with reflux nephropathy, and 2 with ureteropelvic junction obstruction. Out of the 21 patients, 14 (67%) were noted to have normalization of their blood pressure postoperatively. Of the patients with MCDK, 7/11 had normal blood pressure postoperatively compared to 6/9 patients with reflux nephropathy, and 1/2 patients with UPJ obstruction. Of the 14 patients with normalization of blood pressure postoperatively, 7 were on antihypertensives prior to surgery. Four of the 7 patients stopped their antihypertensive medications postoperatively, 2 decreased from 3 and 4 medications to 1, and 1 remained on an ACE inhibitor for renal protection. There were 2 patients with contralateral renal scarring, both of which did not have normalization of blood pressure postoperatively. CONCLUSIONS Nephrectomy in pediatric patients with unilateral parenchymal renal disease and hypertension yields resolution of hypertension in 67% of cases, permitting cessation or diminution of antihypertensives in many patients. Given the alternative of life-long antihypertensives with the risk of medication non-compliance and side-effects, nephrectomy is a logical option of care which should be offered to all such patients with informed knowledge of potential for cure. Dallas, TX© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e176-e177 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Bruce Schlomer More articles by this author Paul Smith More articles by this author Theodore Barber More articles by this author Warren Snodgrass More articles by this author Linda Baker More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...