Hypertension is a common problem in renal failure patients both before and after renal transplantation. The stable allograft can maintain salt, volume, and blood pressure homeostasis and is not intrinsically a hypertensive model. The causes of severe posttransplant hypertension are multiple. Renal vascular tone, body salt and volume status, and renin release are all connected and influenced by immunosuppressive medications, allograft function, and native kidney presence and function. The role of each of these in posttransplant hypertension is reviewed. In most cases, severe hypertension in the stable transplant patient without rejection or transplant renal artery stenosis is greatly improved following native bilateral nephrectomy. Transluminal angioplasty is the preferred initial treatment for transplant renal artery stenosis.
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