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Pre-transplant bilateral native nephrectomy for medically refractory hypertension
R E Power1, J G Calleary, D P Hickey
1Department of Transplantation and Urology, Beaumont Hospital, Dublin, Ireland.
Irish Medical Journal
|November 6, 2001
Summary
Bilateral nephrectomy effectively manages refractory hypertension in patients awaiting kidney transplants, reducing medication needs. This procedure, particularly via dorsal lumbotomy, offers improved outcomes and reduced hospital stays.
Area of Science:
- Nephrology
- Surgical Oncology
- Transplant Surgery
Background:
- Retained native kidneys can cause refractory hypertension, negatively impacting renal transplant outcomes.
- Hypertension is a significant risk factor for both patient and graft survival post-transplantation.
Purpose of the Study:
- To evaluate the efficacy of bilateral nephrectomy in managing refractory hypertension prior to renal transplantation.
- To compare surgical morbidity and outcomes between bilateral dorsal lumbotomy and midline incisions for nephrectomy.
Main Methods:
- A retrospective review of 10 patients who underwent bilateral nephrectomy for refractory hypertension between January 1991 and July 1998.
- Analysis of pre- and post-operative antihypertensive medication requirements, surgical approach (dorsal lumbotomy vs. midline), and post-operative outcomes.
Main Results:
- All 10 patients experienced a reduction in daily antihypertensive medications.
- Bilateral dorsal lumbotomy was associated with less surgical morbidity and shorter hospital stays compared to midline incisions.
- Seven patients with functioning grafts had a mean serum creatinine of 164.14±42.83 micromol/dl at a mean follow-up of 46.43±26.06 months.
Conclusions:
- Bilateral nephrectomy is a viable and effective treatment for refractory hypertension in patients undergoing renal transplantation.
- The bilateral dorsal lumbotomy approach is recommended for its reduced morbidity and shorter hospital stay.