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

• Published in: Journal of pediatric urology 2011-06, Vol.7 (3), p.373-377
• Main Authors: Schlomer, Bruce J, Smith, Paul J, Barber, Theodore D, Baker, Linda A
• Format: Article
• Language: English
• Subjects: Antihypertensive Agents - therapeutic use; Child; Child, Preschool; Female; Humans; Hypertension; Hypertension, Renal - drug therapy; Hypertension, Renal - physiopathology; Hypertension, Renal - surgery; Infant; Kidney - abnormalities; Kidney - physiopathology; Male; Nephrectomy; Pediatric; Pediatrics; Renal parenchymal disease; Retrospective Studies; Urology
• ISSN: 1477-5131; 1873-4898
• DOI: 10.1016/j.jpurol.2011.02.020

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.