Role of laparoscopic nephrectomy for management of symptomatic nephrogenic hypertension.
OBJECTIVE
To investigate the efficacy of laparoscopic nephrectomy for the management of hypertension associated with a unilateral poorly functioning kidney in adults and the role of some variables in the prediction of its outcome in the management of nephrogenic hypertension.


METHODS
We conducted this study on 22 hypertensive patients with a unilateral, minimally functioning kidney. We included patients with a well-functioned contralateral kidney, no renal tumors, no renovascular hypertension, and no diagnosis of end-stage renal disease. All patients had poorly controlled hypertension or preferred to discontinue medical therapy. Their age at the onset of hypertension, gender, age at laparoscopic nephrectomy, and the interval from diagnosis to intervention were evaluated. A complete response was defined as blood pressure normalization without medical treatment. A partial response was defined as a decrease in the medication requirements and/or a 10-mm Hg decrease in diastolic blood pressure after surgery. Measurement of plasma renin activity was not available in our country at the time of the study.


RESULTS
After nephrectomy, 12 (54.5%), 2 (9.1%), and 8 (36.4%) patients had a complete, partial, or no response to the surgery, respectively. No significant association was found between the response to laparoscopic nephrectomy and age, gender, and mean blood pressure. Only the hypertension-related signs and symptoms before surgery were significantly associated with the response to laparoscopic nephrectomy (P = 0.01) on both univariate and multivariate analysis.


CONCLUSIONS
Nephrectomy seems effective for the management of nephrogenic hypertension in patients who wish to discontinue medical therapy. We suggest paying attention to the preoperative hypertension-related symptoms for the prediction of the response to nephrectomy.
Basiri
Abbas
A
Urology and Nephrology Research Center, Labbafinejad Medical Center, Shaheed Beheshti Medical University, Tehran, Iran. h_sasan@hotmail.com
Simforoosh
Naser
N
Abdi
Hamidreza
H
Abdi
Hamid Reza
HR
Shahrokhi
Seyed Saeed
SS
Hosseini-Moghaddam
Seyed Mohammadmehdi
SM
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D005260:Female; D006801:Humans; D006977:Hypertension, Renal / Q000000981:diagnostic imaging / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods* / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods* / Q000706:statistics & numerical data; D012083:Renin / Q000378:metabolism; D014463:Ultrasonography
D012083:Renin