Bilateral nephrectomy prior to renal transplantation

Area of Science:

• Nephrology
• Surgical Procedures
• Renal Transplantation

Background:

• Bilateral nephrectomy is a significant surgical procedure for patients undergoing regular hemodialysis.
• Various renal pathologies necessitate bilateral nephrectomy, impacting patient management and outcomes.

Purpose of the Study:

• To analyze the indications, outcomes, and complications of bilateral nephrectomy in patients on regular hemodialysis.
• To revise the indications for bilateral nephrectomy based on clinical experience and patient outcomes.

Main Methods:

• Retrospective analysis of 53 patients who underwent bilateral nephrectomy while on regular hemodialysis.
• Data collection on indications for surgery, procedure timing relative to transplantation, mortality, and postoperative complications.

Main Results:

• The primary indications included pyelonephritis (30 patients), uncontrollable hypertension (9 patients), glomerulonephritis (7 patients), polycystic kidneys (6 patients), and horseshoe kidney (1 patient).
• The operation was performed prior to transplantation in 87% of cases.
• A 9% mortality rate was observed, with complications such as hypotension, arteriovenous shunt clotting, pneumonia, and subphrenic abscess.

Conclusions:

• Bilateral nephrectomy in hemodialysis patients is associated with considerable mortality and morbidity.
• Revised indications prioritize pyelonephritis with persistent bacteriuria or ureteric reflux, polycystic kidneys, and uncontrollable hypertension to optimize patient selection and outcomes.