MEDICAL VERSUS SURGICAL TREATMENT IN PATIENTS WITH NON-FUNCTIONING KIDNEY

Abstract

Objective: Non-functioning kidney (NFK) can be responsible in whole or in part for hypertension. Patients with a lateralized renin secretion can be treated either medically or surgically. Objective: assess the benefice of nephrectomy over medical treatment in the management of lateralized NFK in hypertensive patients diagnosed after renal vein sampling (RVS). The profit is based on the blood pressure (BP) control, the number of BP lowering drugs or the daily-defined dose (ddd). Design and method: We conducted an observational retrospective study at the Hypertension Unit at Georges-Pompidou European Hospital in France, between January 2004 and January 2021, that analyzes RVS in hypertensive patients. We studied the data (N = 68) at the time of diagnosis and at two follow up visits: the first after RVS or nephrectomy (V1) and the last visit (V2). Results: At V1, in patients with a lateralized NFK: - 18 underwent nephrectomy: 11 vascular disease, 4 urologic disease, 2 trauma and 1 another cause.- 5 were treated medically: all had a vascular disease In patients who underwent nephrectomy, between the diagnosis, V1 and V2 (N = 12) respectively: In patients with medical treatment, between the diagnosis, V1 and V2 (N = 4) respectively: a) systolic BP dropped from 189 to 170,33 to 133,33 mmHgb) number of molecules increased from 3 to 4,8 at V1 and V2c) ddd increased from 63,35 to 118,3 to 267d) at V1 and V2: 1 had a controlled HTN Conclusions: In patients with lateralized NFK, nephrectomy helps in the control of the BP and reduces systolic BP, number of drugs and ddd. The effect on the BP control seems not to be maintained on the long term. Further studies, with a bigger sample, are needed to define subgroups that can benefit the most from nephrectomy.