Hypertension after surgical management of renal duplication associated with an upper pole ureterocele

Duplicated upper pole systems associated with a ureterocele frequently have areas of segmental renal dysplasia. Since dysplasia has been related to the development of renin mediated hypertension, we hypothesized that preservation of functional upper pole moieties may result in an increased incidence of high blood pressure.

We evaluated 115 patients with a history of renal duplication and an ipsilateral upper pole ureterocele. Patients were separated into group 1-nonfunctional upper pole managed by partial nephrectomy, group 2-functional upper pole moiety managed by partial nephrectomy and group 3-functional upper pole moiety managed by a nephron sparing procedure. All charts were reviewed for hypertension, febrile urinary tract infection, vesicoureteral reflux and renal scarring.

At a median followup age of 15 years (range 1 to 33) hypertension developed in 13 of the 115 patients (11%), including 8 of the 87 (9%) with nonfunctional upper pole systems managed by partial nephrectomy, 1 of the 12 (8%) with a functional upper pole moiety managed by partial nephrectomy and 4 of the 16 (25%) with a functional upper pole system managed by an upper pole salvage procedure. Statistical evaluations failed to reveal any relationship between hypertension and preservation of the upper pole system or between hypertension and vesicoureteral reflux. Rather, elevation in blood pressure was found to be related to development of a renal scar after a febrile urinary tract infection.

Hypertension in patients with a history of renal duplication associated with a ureterocele is directly related to renal scarring.