Unilateral Parenchymatous Kidney Disease and Hypertension: Results of Nephrectomy and Medical Treatment

Abstract

In the present study 43 patients with unilateral parenchymatous kidney disease and hypertension were investigated. 20 patients were nephrectomized, 23 treated with antihypertensive drugs. Both therapeutic approaches showed an excellent and sustained blood pressure-(BP)-lowering effect. BP fell from 185 ± 27/116 ± 13 to 138 ± 20/86 ± 10 mm Hg in the operated and from 194 ± 32/116 ± 13 to 149 ± 22/95 ± 12 mm Hg in the medically treated patients after 2 and 6 weeks, respectively (p < 0.001). BP was 142 ± 16/89 ± 11 and 136+ 16/90 ± 10 mm Hg at the long-term follow-up in the 2 subgroups. In the operated group 70% (n = 14) were cured, 20% (n = 4) were improved and 10% (n = 2) unimproved. In the medically treated group 65% (n = 15) were normotensive, 26% (n = 6) improved and 9% (n = 2) treatment resistant. No significant correlation between postoperative BP reduction and lateralization of renin secretion (PRA-ratio > 1.5) was found. Although cured patients showed a higher mean PRA-ratio, 4 patients with a PRA-ratio < 1.5 were cured (n = 2) or improved (n = 2) postoperatively. Our results document an excellent and sustained antihypertensive effect of both nephrectomy and medical treatment in patients with unilateral parenchymatous kidney disease and hypertension. They further limit the predictive value of renal venous renin determination in the preoperative workup.