Relation of arterial hypertension with kidney in patients before and after removal of pheochromocytoma

Abstract

Kidney state was studied in 28 patients (pts) before removal of pheochromocytoma (pheo) as well as during one year after operation (Group 1), and in 84 pts in 2-29 years after surgery (Group 2). All pts with pheo (48 m and 64 w, aged 45,1±1,3 year, range 12-70) had hypertension. Before operation patients in Group 1 had nycturia and polyuria (16,6%), proteinuria (91,3%), microhematuria (35%), cylinderuria (39%), decreased glomerular filtration (42%), transient increase of blood creatinine during paroxysms of hypertension (13,3%), increased plasma renin activity (65,2%) and concentation of aldosteron (43,5%). In one case hydronephrosis was related to extraadrenal tumor generating pressure on ureter, and after operation diagnosis of pyelonephritis was made. 3 pts had renal artery stenosis (one case of renal artery pressed by tumor, and two cases of functional renal stenosis veryfied by operation). Marked changes of intrarenal arteries and renal parenchyma because of severe prolonged hypertension (21,5%) and signs of hyperfunction of juxtaglomerular apparatus (26%) were seen by intraoperative kidney biopsy (n=23). After operation there was normalization of kidney functional state in all pts of Group 1. During one year after operation 11 of 112 pts (9,8%) had moderate or severe residual hypertension related to kidney hypertensive arteriolosclerosis. During remote period after removal of pheo 24 pts of group 2 became hypertensive again, but only in 3 pts concomitant kidney diseases were revealed (calculary pyelonephritis, diabetic nephropathy, pathological mobility). 13 pts in Group 2 also had concomitant renal diseases or congenital anomalies but they were normotensive. We can conclude that changes of kidney function in pheo, and especially marked proteinuria, are not signs of kidney organic parenchymal affection. Kidney hypertensive arteriolosclerosis and renal artery stenosises in pheo can make arterial hypertension more severe. Kidney hypertensive arteriolosclerosis can be cause of hypertension soon after removal of pheo, as well as concomitant renal diseases in remote period after operation.