Nephrectomy for hypertension in pediatric patients with a unilateral poorly functioning kidney: A contemporary cohort

Bruce J. Schlomer, Paul J. Smith, Theodore D. Barber, Linda A. Baker

Research output: Contribution to journalArticle

10 Scopus citations

Abstract

Purpose: 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. Materials and 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.

Original languageEnglish (US)
Pages (from-to)373-377
Number of pages5
JournalJournal of Pediatric Urology
Volume7
Issue number3
DOIs
StatePublished - Jun 1 2011

Keywords

  • Hypertension
  • Nephrectomy
  • Pediatric
  • Renal parenchymal disease

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Urology

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