Changes of arterial pressure following relief of obstruction in adults with hydronephrosis

• Published in: Upsala journal of medical sciences 2018-01, Vol.123 (4), p.216-224
• Main Authors: Al-Mashhadi, Ammar, Häggman, Michael, Läckgren, Göran, Ladjevardi, Sam, Nevéus, Tryggve, Stenberg, Arne, Persson, A. Erik G., Carlström, Mattias
• Format: Article
• Language: English
• Subjects: Blood pressure; hydronephrosis; hypertension; kidney; Medicin och hälsovetenskap; renal function; ureteral obstruction
• ISSN: 0300-9734; 2000-1967; 2000-1967
• DOI: 10.1080/03009734.2018.1521890

Background: As much as 20% of all cases of hypertension are associated with kidney malfunctions. We have previously demonstrated in animals and in pediatric patients that hydronephrosis causes hypertension, which was attenuated by surgical relief of the ureteropelvic junction (UPJ) obstruction. This retrospective cohort study aimed to investigate: (1) the proposed link between hydronephrosis, due to UPJ obstruction, and elevated arterial pressure in adults; and (2) if elevated blood pressure in patients with hydronephrosis might be another indication for surgery. Materials and methods: Medical records of 212 patients undergoing surgical management of hydronephrosis, due to UPJ obstruction, between 2000 and 2016 were assessed. After excluding patients with confounding conditions and treatments, paired arterial pressures (i.e. before/after surgery) were compared in 49 patients (35 years old; 95% CI 29-39). Split renal function was evaluated by using mercaptoacetyltriglycine (MAG3) renography before surgical management of the hydronephrotic kidney. Results: Systolic (−11 mmHg; 95% CI 6-15 mmHg), diastolic (−8 mmHg; 95% CI 4-11 mmHg), and mean arterial (-9 mmHg; 95% CI 6-12) pressures were significantly reduced after relief of the obstruction (p