Pre-transplant bilateral native nephrectomy for medically refractory hypertension

Hypertension arising from retained native kidneys can compromise both the patient and graft survival. Bilateral nephrectomy should be considered in a select group of patients, whom have refractory hypertension, prior to renal transplantation. Between January 1991 and July 1998 we performed 10 bilateral nephrectomies where hypertension was the indication. The mean age was 23 yrs (range 11-45) at the time of surgery. Nine patients were on dialysis pre-operatively (6-H/D, 3-CAPD). All 10 patients witnessed a reduction in the number of antihypertensive medications they were obliged to take daily. We also found less surgical morbidity associated with performing surgery through bilateral dorsal lumbotomy incisions as opposed to through a midline incision. Also the post-operative hospital stay was less in the patient group who under went bilateral dorsal lumbotomy. Seven patients at a mean follow up period of 46.43+/-26.06 months have functioning grafts with a mean serum creatinine of 164.14+/-42.83 micromol/dl. We have shown in our patient group how bilateral nephrectomy can be successfully used for refractory hypertension in patients prior to renal transplantation. We also believe that where possible these kidneys should be removed through a bilateral dorsal lumbotomy incision rather than a midline one.