title: Single-side renal sympathetic denervation to treat malignant refractory hypertension in a solitary kidney patient.
abstract: Renal sympathetic denervation (RSD) is emerging as a new therapeutic option for patients with severe hypertension refractory to medical therapy. Patients affected by renovascular or anatomical abnormalities have hitherto been systematically excluded from clinical trials with RSD because of concern about safety and the unknown efficacy of the procedure in this subgroup of patients. We describe the management of a case of RSD in a single-kidney patient with refractory hypertension; the patient had had a previous surgical right nephrectomy for renal cell carcinoma that subsequently required no other oncologic treatment. After multidisciplinary assessment, the patient underwent RSD. The procedure was performed through a 6F femoral access using the Symplicity™ RSD system (Medtronic, Mountain View, CA, USA). Radiofrequency was applied to the renal artery wall in 6 different points under general sedation with midazolam to control back pain caused by the procedure, that was performed without periprocedural complications. The patient was discharged 2 days later after a control of the vascular access site and routine biochemical examinations. The following 9-month follow up showed a significant reduction in blood pressure and stable renal function, without signs of renal damage. Our report confirms the feasibility of RSD in this delicate context, without evident negative effects on kidney function and with a significant reduction in blood pressure. Future studies are needed to fully clarify the value of RSD in single-kidney patients.
authors: Department of Medicine, University of Verona, Verona, Italy. flavio.ribichini@univr.it.
authors: Flavio
authors: F
authors: Ribichini
authors: Department of Medicine, University of Verona, Verona, Italy.
authors: Angela
authors: A
authors: Ferrara
authors: Department of Medicine, University of Verona, Verona, Italy.
authors: Michele
authors: M
authors: Pighi
authors: Department of Medicine, University of Verona, Verona, Italy.
authors: Gabriele
authors: G
authors: Pesarini
authors: Department of Medicine, University of Verona, Verona, Italy.
authors: Alessia
authors: A
authors: Gambaro
authors: Department of Medicine, University of Verona, Verona, Italy.
authors: Enrico
authors: E
authors: Valvo
authors: Department of Medicine, University of Verona, Verona, Italy.
authors: Antonio
authors: A
authors: Lupo
authors: Department of Medicine, University of Verona, Verona, Italy.
authors: Corrado
authors: C
authors: Vassanelli
mesh_terms: D000959:Antihypertensive Agents / Q000627:therapeutic use; D001027:Aortography; D001794:Blood Pressure / Q000187:drug effects; D018660:Blood Pressure Monitoring, Ambulatory; D017115:Catheter Ablation; D004351:Drug Resistance; D006801:Humans; D006974:Hypertension, Malignant / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D007668:Kidney / Q000294:innervation*; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy; D013562:Sympathectomy / Q000379:methods*; D016896:Treatment Outcome
chemical_list: D000959:Antihypertensive Agents
keywords: Refractory hypertension; Renal sympathetic denervation; Solitary-kidney