title: Nephrectomy for hypertension in pediatric patients with a unilateral poorly functioning kidney: a contemporary cohort.
abstract: OBJECTIVE
  A unilateral poorly or non-functioning kidney is a cause of hypertension in children. We report the outcomes of pediatric patients with unilateral renal parenchymal disease who underwent nephrectomy for hypertension.
  
  
  METHODS
  Consecutive hypertensive children undergoing nephrectomy with a unilateral poorly or non-functioning kidney were retrospectively reviewed; preoperative and postoperative clinical variables were analyzed.
  
  
  RESULTS
  From July 2002 to August 2009, 21 patients (8M:13F) with average age 3.5 years and average follow-up 17.8 months were studied. Eleven patients had multicystic dysplastic kidney, 8 had reflux nephropathy, and 2 had ureteropelvic junction obstruction. Fourteen of 21 (67%) had blood pressure normalization after nephrectomy. Seven of 11 with MCDK were normotensive postoperatively compared to 6/8 patients with reflux nephropathy, and 1/2 patients with UPJ obstruction. Of the 14 patients normotensive postoperatively, 7 were on antihypertensives prior to surgery. Four of 7 patients stopped their anti-hypertensive medications postoperatively, 2 decreased from 3 and 4 medications to 1, and 1 remained on an ACE inhibitor. There were 2 patients with contralateral renal scarring, both of which remained hypertensive postoperatively.
  
  
  CONCLUSIONS
  Nephrectomy in hypertensive pediatric patients with a unilateral poorly functioning or non-functioning kidney yielded hypertension resolution in 67% (14/21), permitting cessation or diminution of antihypertensives in many patients. Given the alternative of lifelong antihypertensives with the risk of medication non-compliance and side-effects, nephrectomy is a logical option of care which can be offered to patients and families with informed knowledge of the potential for cure.
authors.affiliation: UT Southwestern Department of Urology, 5323 Harry Hines Blvd., Dallas, TX 75390-9110, USA.
authors.forename: Bruce J
authors.initials: BJ
authors.lastname: Schlomer
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Smith
authors.forename: Theodore D
authors.initials: TD
authors.lastname: Barber
authors.forename: Linda A
authors.initials: LA
authors.lastname: Baker
mesh_terms: D000959:Antihypertensive Agents / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D006977:Hypertension, Renal / Q000188:drug therapy / Q000503:physiopathology / Q000601:surgery*; D007223:Infant; D007668:Kidney / Q000002:abnormalities / Q000503:physiopathology; D008297:Male; D009392:Nephrectomy; D012189:Retrospective Studies
chemical_list: D000959:Antihypertensive Agents