Siew Yi Lee1, Howard Lau. 1. Westmead Hospital, Sydney, Australia. Siewyi_lee@yahoo.com
Abstract
OBJECTIVE: This study investigated the effectiveness of unilateral nephrectomy in the treatment of renal hypertension in adults with an atrophic kidney, and set out to establish whether this is an appropriate mode of treatment for renal hypertension not otherwise controlled by antihypertensive drugs or other surgical procedures. METHODS: We conducted a retrospective review of 600 consecutive patients who underwent laparoscopic renal surgery from 1998 to 2006 by a single surgeon. Seventeen underwent unilateral nephrectomy for the management of uncontrolled renal hypertension to remove a non-functioning, scarred, and contracted kidney. All patients had normal contralateral kidneys and normal renal functions preoperatively. Results were analysed by Wilcoxon's signed rank test. Statistically significant results (p < 0.0001) with a mean reduction in systolic blood pressure of 27 mmHg and diastolic blood pressure of 17.5 mmHg, more than 6 months after unilateral nephrectomy for treatment of renal hypertension were consistently maintained. RESULTS: Of the potential modifying factors related to reduction in blood pressure, only age was found to modify the reduction in systolic blood pressure, with a Spearman's rank correlation coefficient of -0.538 (p = 0.026). At 6 months, the mean reduction in systolic blood pressure was 27 mmHg and that for diastolic blood pressure was 17.5 mmHg (p < 0.0001, Wilcoxon's signed rank test). CONCLUSION: Our data suggest that patients with renal hypertension and unilateral kidney atrophy, treated with laparoscopic nephrectomy, have significant, effective and at least medium term blood pressure control.
OBJECTIVE: This study investigated the effectiveness of unilateral nephrectomy in the treatment of renal hypertension in adults with an atrophic kidney, and set out to establish whether this is an appropriate mode of treatment for renal hypertension not otherwise controlled by antihypertensive drugs or other surgical procedures. METHODS: We conducted a retrospective review of 600 consecutive patients who underwent laparoscopic renal surgery from 1998 to 2006 by a single surgeon. Seventeen underwent unilateral nephrectomy for the management of uncontrolled renal hypertension to remove a non-functioning, scarred, and contracted kidney. All patients had normal contralateral kidneys and normal renal functions preoperatively. Results were analysed by Wilcoxon's signed rank test. Statistically significant results (p < 0.0001) with a mean reduction in systolic blood pressure of 27 mmHg and diastolic blood pressure of 17.5 mmHg, more than 6 months after unilateral nephrectomy for treatment of renal hypertension were consistently maintained. RESULTS: Of the potential modifying factors related to reduction in blood pressure, only age was found to modify the reduction in systolic blood pressure, with a Spearman's rank correlation coefficient of -0.538 (p = 0.026). At 6 months, the mean reduction in systolic blood pressure was 27 mmHg and that for diastolic blood pressure was 17.5 mmHg (p < 0.0001, Wilcoxon's signed rank test). CONCLUSION: Our data suggest that patients with renal hypertension and unilateral kidney atrophy, treated with laparoscopic nephrectomy, have significant, effective and at least medium term blood pressure control.