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Native Nephrectomy with Renal Transplantation is Associated with a Decrease in Hypertension Medication Requirements

Ashley M Shumate1, Clinton D Bahler1, William C Goggins2

  • 1Department of Urology, Indiana University, Indianapolis, Indiana.

The Journal of Urology
|August 31, 2015
PubMed
Summary

Concurrent native nephrectomy with renal transplantation significantly reduces antihypertensive drug use in autosomal dominant polycystic kidney disease patients. Delayed contralateral nephrectomy further improves blood pressure control.

Keywords:
autosomal dominantdrug dosage calculationshypertensionkidney transplantationnephrectomypolycystic kidney

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Area of Science:

  • Nephrology
  • Cardiology
  • Transplantation Surgery

Background:

  • Autosomal dominant polycystic kidney disease (ADPKD) is a common genetic disorder.
  • Hypertension is a frequent complication of ADPKD, often requiring management with antihypertensive medications.
  • Renal transplantation is a definitive treatment for end-stage renal disease in ADPKD patients.

Purpose of the Study:

  • To evaluate the impact of native nephrectomy on blood pressure control in ADPKD patients undergoing renal transplantation.
  • To compare hypertensive control between renal transplantation alone versus transplantation with concurrent or delayed native nephrectomy.

Main Methods:

  • Retrospective study of 118 ADPKD patients undergoing renal transplantation (2003-2013).
  • Patients were divided into: transplantation alone (n=54), transplantation with concurrent ipsilateral nephrectomy (n=32), and transplantation with delayed contralateral nephrectomy (n=32).
  • Antihypertensive medication quantity and defined daily dose (DDD) were recorded pre- and post-transplantation up to 36 months.

Main Results:

  • Concurrent ipsilateral nephrectomy showed a significant decrease in antihypertensive medication quantity and DDD compared to transplantation alone at 12, 24, and 36 months.
  • Native nephrectomy remained a predictor of reduced antihypertensive requirements.
  • Delayed contralateral nephrectomy led to a further mean decrease of -0.6 medications and -0.6 DDD at 12 months post-procedure.

Conclusions:

  • Concurrent ipsilateral native nephrectomy significantly improves hypertension management post-renal transplantation in ADPKD.
  • Delayed contralateral native nephrectomy offers even greater benefits for blood pressure control in these patients.