Roma Subhash Varik1, Arash Taghizadeh2, Massimo Garriboli2,3, Kalpana Patil2, Anu Paul2, Joanna Clothier4, Manish D Sinha4, Pankaj Mishra2. 1. Department of Paediatric Urology, Evelina London Children's Hospital, Westminster Bridge Road, Lambeth, SE1 7EH, UK. romavarik@gmail.com. 2. Department of Paediatric Urology, Evelina London Children's Hospital, Westminster Bridge Road, Lambeth, SE1 7EH, UK. 3. Stem Cells and Regenerative Medicine Section, Developmental Biology and Cancer Programme, UCL Institute of Child Health, London, UK. 4. Department of Paediatric Nephro-Urology, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, Westminster Bridge Rd, Lambeth, SE1 7EH, UK.
Abstract
AIM: Hypertension in children with abnormal kidneys often requires multiple antihypertensive agents (complex), or could present with complications (e.g. hypertensive encephalopathy). Our objective in this report is to evaluate blood pressure control following unilateral or bilateral laparoscopic native nephrectomy in children with renal hypertension. MATERIALS AND METHODS: Single-centre retrospective review of all children who underwent nephrectomy for management of hypertension over a recent study period (2008-2017) with post-operative follow-up of at least 3 years. We describe the association of age, primary kidney disease and blood pressure and its management including time to resolution following unilateral or bilateral nephrectomy. RESULTS: During the 9-year study period, 21 of 215 (9.8%) children underwent nephrectomy for management of hypertension. We included 19 children [6 with unilateral native nephrectomy (UNN) and 13 with bilateral native nephrectomy (BNN)] in this study as they continued with their follow-up at our centre. Out of the 19 children, 15 had laparoscopic retroperitoneoscopic nephrectomies and 4 had laparoscopic transperitoneal nephrectomies. Six children had unilateral nephrectomy and 13 children had bilateral nephrectomies [7 were pre-transplant (haemodialysis-6, peritoneal dialysis-1) and 6 were post-kidney transplant]. Fifteen of 19 children (79%) had complete resolution [5 UNN and 10 BNN] and 3 (16%) partial resolution [1 UNN and 2 BNN]. One patient with BNN was observed to have no change in blood pressure control. CONCLUSION: Our data demonstrate improved management of hypertension in 95% of the children. Nephrectomy could offer a reasonable treatment option for selected group of complex and complicated renal hypertension.
AIM: Hypertension in children with abnormal kidneys often requires multiple antihypertensive agents (complex), or could present with complications (e.g. hypertensive encephalopathy). Our objective in this report is to evaluate blood pressure control following unilateral or bilateral laparoscopic native nephrectomy in children with renal hypertension. MATERIALS AND METHODS: Single-centre retrospective review of all children who underwent nephrectomy for management of hypertension over a recent study period (2008-2017) with post-operative follow-up of at least 3 years. We describe the association of age, primary kidney disease and blood pressure and its management including time to resolution following unilateral or bilateral nephrectomy. RESULTS: During the 9-year study period, 21 of 215 (9.8%) children underwent nephrectomy for management of hypertension. We included 19 children [6 with unilateral native nephrectomy (UNN) and 13 with bilateral native nephrectomy (BNN)] in this study as they continued with their follow-up at our centre. Out of the 19 children, 15 had laparoscopic retroperitoneoscopic nephrectomies and 4 had laparoscopic transperitoneal nephrectomies. Six children had unilateral nephrectomy and 13 children had bilateral nephrectomies [7 were pre-transplant (haemodialysis-6, peritoneal dialysis-1) and 6 were post-kidney transplant]. Fifteen of 19 children (79%) had complete resolution [5 UNN and 10 BNN] and 3 (16%) partial resolution [1 UNN and 2 BNN]. One patient with BNN was observed to have no change in blood pressure control. CONCLUSION: Our data demonstrate improved management of hypertension in 95% of the children. Nephrectomy could offer a reasonable treatment option for selected group of complex and complicated renal hypertension.
Authors: Joseph T Flynn; David C Kaelber; Carissa M Baker-Smith; Douglas Blowey; Aaron E Carroll; Stephen R Daniels; Sarah D de Ferranti; Janis M Dionne; Bonita Falkner; Susan K Flinn; Samuel S Gidding; Celeste Goodwin; Michael G Leu; Makia E Powers; Corinna Rea; Joshua Samuels; Madeline Simasek; Vidhu V Thaker; Elaine M Urbina Journal: Pediatrics Date: 2017-08-21 Impact factor: 7.124
Authors: Luis G Báez-Trinidad; Thomas S Lendvay; Bruce H Broecker; Edwin A Smith; Barry L Warshaw; Leonard Hymes; Andrew J Kirsch Journal: J Urol Date: 2003-10 Impact factor: 7.450