Abstract: SA-PO382
Bilateral Nephrectomy as a Salvage Therapy for Resistant Hypertension in ESKD
Session Information
- Hypertension, CVD, and the Kidneys: Clinical Research
October 26, 2024 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Hypertension and CVD
- 1602 Hypertension and CVD: Clinical
Authors
- Shahid, Wajeeha, The Wright Center for Graduate Medical Education, Scranton, Pennsylvania, United States
- Ali, Awiza, Patel Hospital, Karachi, Sindh, Pakistan
- Rafique, Waris, Patel Hospital, Karachi, Sindh, Pakistan
- Shahid, Talha, Liaquat College of Medicine and Dentistry, Karachi, Pakistan
- Mushtaq, Mehdi, Patel Hospital, Karachi, Sindh, Pakistan
Introduction
Chronic hemodialysis patients face challenge with resistant hypertension and exhibit resistant to volume control and antihypertensive medications. Although bilateral nephrectomy has shown promising outcomes, it appears to be an underutilized option.
Case Description
30 years male, past medical history of hypertension, hyperlipidemia, ESRD on intermittent hemodialysis admitted to the hospital with hypertensive emergency, systolic BP > 200, complicated with non-ST-elevation myocardial infarction, diastolic heart failure, pleural effusion. The patient's antihypertensive regimen included clonidine, hydralazine, methyldopa, lisinopril, doxazosin, nifedipine, and spironolactone. Minoxil was unavailable in country and was not used. The patient's BP was controlled with the addition of intravenous glyceryltrinitrate.
The secondary causes of resistant hypertension in this patient were investigated, serum renin and aldosterone level came normal, plasma free metanephrine level was also unremarkable, renal angiogram was negative for large vessel stenosis only tortuous and anomalous origin of renal arteries was noted.The patient remained dependent on a glyceryltrinitrate drip despite >7 oral antihypertensives and daily four-hours hemodialysis sessions and intensive ultrafiltration. Choices for the treatment of this patient's refractory hypertension were considered, including renal denervation and bilateral nephrectomy. Interdisciplinary meetings resulted to proceed with bilateral nephrectomy. The option of renal denervation was postponed due to its invasive nature and unproven effectiveness.
The patient underwent a bilateral nephrectomy without any significant complications. Following the procedure, the patient was closely monitored in the intensive care unit for a week. Subsequently, the patient’s blood pressure gradually normalized over a three-month period. Post-surgery, Lisinopril was stopped, labetalol was discontinued after one month, and the doses of other antihypertensive medications were gradually reduced.
Discussion
The prevalence of bilateral nephrectomy as a treatment option ranges from 0 to 7% in various countries.[1] Bilateral nephrectomy leads to reduction in the levels of renin, angiotensin and aldosterone, which subsequently lowers the BP in resistant hypertension.[2]
[1]doi: 10.1016/j.ijscr.2022.107566
[2]doi: 10.7759/cureus.9031