[Is persistent arterial hypertension in patients on renal replacement therapy still an indication for bilateral native nephrectomy?]

Abstract

Arterial hypertension (AHT) is common clinical symptom in 80% of patients at start of chronic dialysis and at 1 year remains overt in 50% of hemodialyzed and 30% of patients on peritoneal dialysis. The incidence of AHT post-transplant is 58% in long-term follow-up. The mechanism of AHT is complex, however in dialyzed patients the most common factor is (overt or hidden) fluid overload (volume-dependent AHT). It develops as a consequence of inadequate evaluation of body dry mass and/or insufficient dialysis technique. Post-transplant AHT may develop as side-effect of long-term calcineurine inhibitors and steroid therapy and/or high renin production by native kidneys. In patients with chronic allograft nephropathy complex pathology of renal failure becomes more important factor. The data concerning efficacy of bilateral native nephrectomy are inconsistent. NAPRTCS survey data show, that incidence of AHT is similar in nephrectomized and non-nephrectomized patients up to 5 years post-transplant. In nephrectomized dialyzed patients fluid overload is still a main cause of AHT. Many therapeutic modalities, both pharmacological and dialysis-related, are available to improve blood pressure regulation. Bilateral native nephrectomy should be regarded as the last option, mostly in patients with ongoing renal co-morbidities, such as heavy proteinuria or recurrent urinary tract infection.