Connections between renovascular hypertension and nephrectomy

Renovascular hypertension (RVH) is very often an under-diagnosed condition, being discovered incidentally, at a routine medical check-up or during a medical examination for another disease. A number of 217 biological samples (kidney and renal pelvis) resulting from the nephrectomies performed during the period 2008-2009 in the Urology Clinic of Oradea County Hospital have been taken into study. These samples were processed in the Pathology Laboratory of the same hospital. The distribution of nephrectomies according to the urological diagnosis has shown that 38.2% of the patients underwent surgical procedure for renal parenchymal malignant tumor (Grawitz tumor). Out of the 83 nephrectomies caused by renal tumor, in eight cases, benign and malignant angiosclerosis histological changes were seen, which demonstrates a long evolution of hypertension. Its clinical symptoms were masked by those triggered by the tumor. Histopathological changes of benign nephroangiosclerosis with arteriolar vasospasm associated with edema of the wall and/or hypertrophy of the intima with the formation of hyaline deposits were found in three nephrectomies due to hydronephrosis. The pathological study carried on samples obtained from nephrectomies showed that the symptoms of RVH are hidden or accompanied by clinical manifestations of a surgical disease. The percentage of 8.8% of the patients that had histopathologic changes or malignant of benign nephroangio-sclerosis and suffered nephrectomies for a surgical disease is quite small compared to the large number of nephrectomies. It is imperative to identify in due time the secondary mechanism of hypertension in order to perform the surgical intervention which saves the kidney or prevents the extension to other organs. Although no special investigations were performed showing a possible preoperative RVH, it can be stated that the renal origin of the arterial hypertension can be established retrospectively, after nephrectomy. The monitoring of blood pressure values during several years is extremely important for establishing the etiology of renal hypertension.