THE HETEROGENEOUS AND DELAYED COURSE OF BLOOD PRESSURE NORMALIZATION IN HYPERTENSIVE PATIENTS AFTER BILATERAL NEPHRECTOMY WITH AND WITHOUT SUBSEQUENT RENAL TRANSPLANTATION

Abstract

CONDENSED ABSTRACTControversy exists about the time course of blood pressure normalization in hypertensive patients after bilateral nephrectomy. The course of blood pressure was retrospectively assessed in 14 hypertensive patients. Bilateral nephrectomy resulted in a decrease of blood pressure within 6 months following surgery. Combined antihypertensive medication was necessary in most patients with renovascular hypertension even after bilateral nephrectomy. Subsequent renal transplantation following bilateral nephrectomy caused de novo increase in blood pressure in formerly hypertensive patients.Background. Controversy exists about the time course of blood pressure normalization following bilateral nephrectomy. We sought to evaluate the time course of blood pressure normalization following bilateral nephrectomy and after subsequent kidney transplantation.Methods and Results. Clinical data from 14 hypertensive patients were retrospectively assessed. Baseline blood pressure was 175 ± 33/109 ± 9 mmHg. Ten patients firstly underwent unilateral nephrectomy, which resulted in a slight increase of blood pressure (185 ± 22/110 ± 5 mmHg). One month following bilateral nephrectomy, blood pressure was 167 ± 23/104 ± 17 mmHg, at 3 months 159 ± 42/104 ± 25 mmHg, and at 6 months 149 ± 41/96 ± 30 mmHg. Antihypertensive medication was necessary in 9/14 patients at a 2 year follow-up. Eight patients remained anephric (group I), 6 patients had subsequent kidney transplantation (group II). In group I, blood pressure was 159 ± 42/93 ± 17 mmHg and 129 ± 34/75 ± 14 mmHg at 3 and 6 months, respectively (p < 0.05 vs. baseline). In group II, blood pressure decreased from 188 ± 42/128 ± 46 mmHg to 167 ± 48/113 ± 32 mmHg at 3 months, but increased after tansplantation to 186 ± 39/118 ± 33 mmHg. Antihypertensive medication was still necessary in 5 transplanted patients (83%) and in 3 anephric patients (38%).Conclusion. Adaptation of the blood pressure response following bilateral nephrectomy is a time requiring process, and long-term antihypertensive medication may still be necessary.