Percutaneous Transcatheter Renal Ablation With Absolute Ethanol for Uncontrolled Hypertension or Nephrotic Syndrome: Results in 11 Patients With End-Stage Renal Disease

Abstract

Purpose Retrospective review of authors' experience with percutaneous transcatheter renal ablation in patients with uncontrolled hypertension and/or nephrotic syndrome. Materials and Methods Between April 1987 and September 1995, renal ablation was performed on 11 patients aged 10 months to 21 years. All patients had end-stage renal disease (ESRD) with uncontrolled hypertension (10 patients) and/or nephrotic syndrome (four patients). Uncontrolled hypertension was defined as diastolic pressure greater than 90 mm Hg despite multidrug anti-hypertensive therapy. Nephrotic syndrome was defined as protein-uria exceeding 960 mg/m 2 per day, serum albumin level less than 3 g/dL, and generalized edema. Embolization was performed with absolute ethanol from a common femoral artery approach. In most cases, a balloon catheter was used to prevent alcohol reflux into the aorta or nontarget renal artery branches, such as the adrenal arteries. Angiographic stasis of contrast material in the renal arteries was the endpoint. Results All patients experienced a postembolization syndrome of 3–5 days duration, clinically manifested by variable degrees of nausea, vomiting, fever, and pain. Long-term improvement in hypertension was observed in nine patients. Improvement in hypertension was defined as diastolic blood pressure below 90 mm Hg while the patient received the same or fewer antihypertensive medications. The four patients with nephrotic syndrome were cured of their proteinuria and edema. Conclusions Transarterial renal ablation with alcohol is efficacious for treatment of uncontrolled hypertension and nephrotic syndrome in patients with ESRD. The morbidity and mortality in our series were less than those reported for surgical nephrectomy.