Nephrectomy in selected patients with severe refractory hypertension receiving dialysis

The effect of bilateral nephrectomy was examined in ten patients with severe hypertension in whom dialysis and multiple drug therapy had not resulted in blood pressure control and was compared with that in 15 patients undergoing nephrectomy solely in preparation for transplantation. A highly significant, P less than 0.0005, and clinically impressive reduction in mean blood pressure occurred in the first group of patients, permitting discontinuation of all drugs. Although impossible to quantitate, these patients also demonstrated a reversal of a failure-to-thrive syndrome which had seriously compromides prenephrectomy management. Nephrectomy resulted in a reduction in mean hematocrit values of greater than 20 per cent and less than or equal to 20 percent showed a significant fall in the former but not in the latter. No increase in transfusion requirements developed in these patients. Until more potent and reliable medical therapy becomes generally availabe, nephrectomy will remain an important treatment modality in those patients requiring dialysis and having severe unremitting hypertension.