Abstract The increased appreciation of the role of renin in the pathogenesis of hypertension and the availability of chronic maintenance hemodialysis, during the past decade, laid the groundwork for a new and totally different approach to the treatment of patients with end-stage renal disease and hypertension. As a result, from 1963 to 1968, several reports appeared in the literature regarding the effectiveness of bilateral nephrectomy in the control of severe hypertension in these patients.1-4 In 1969, Vertes and associates5 presented evidence on the basis of which hypertensive patients on chronic dialysis could be divided into two distinct groups. The first, with normal or slightly elevated renin levels, would become normotensive without antihypertensive therapy as long as they received ultrafiltration sufficient to maintain their dry weight. The second, with very high levels of plasma renin activity, would remain hypertensive despite the attainment of dry weight and would manifest a poor References 1. Seto D, et al: Effect of bilateral nephrectomy and of sodium and water content on hypertension. Trans Am Soc Artif Intern Organs 9:35-43, 1963. 2. Kolff WJ, et al: Effect of bilateral nephrectomy and kidney transplantation on hypertension in man. Circulation 30( (suppl 2) ):23-35, 1964.Crossref 3. Toussaint CH, et al: L'hypertension arterielle maligne incontrolable, indication a la nephrectomie bilaterale dans le mal de Bright au stade ultime , in Kerr DNS (ed): Replacement of Renal Function: Proceedings of the European Dialysis and Transplant Association, Third Conference, Lyon, France, June 1966 , Excerpta Medica International Congress Series 131. Amsterdam, Excerpta Medica Foundation, 1967, pp 65-74. 4. Onesti G, et al: Bilateral nephrectomy for control of hypertension in uremia. Trans Am Soc Artif Intern Organs 14:361-366, 1968. 5. Vertes V, et al: Hypertension in endstage renal disease. N Engl J Med 280:978-981, 1969.Crossref 6. Hampers CL, et al: Hemodynamic and body composition changes following bilateral nephrectomy in chronic renal failure. Circulation 40:367-376, 1969.Crossref 7. Wilkinson R, et al: Plasma renin and exchangeable sodium in the hypertension of chronic renal failure. Q J Med 39:377-394, 1970. 8. Donohu JP, et al: Bilateral nephrectomy: Its role in management of the malignant hypertension of end-stage renal disease. J Urol 106:448-491, 1971. 9. Chrysanthakopoulos SG, et al: Hypertension in patients on maintenance hemodialysis: Evaluation of peripheral renin activity and bilateral nephrectomy. Am J Med Sci 264:9-21, 1972.Crossref 10. Lazarus JM, et al: Urgent bilateral nephrectomy for severe hypertension. Ann Intern Med 76:733-739, 1972.Crossref 11. Mroczek WJ: Malignant hypertension: Kidneys too good to be extirpated. Ann Intern Med 80:754-757, 1974.Crossref 12. Mroczek WJ, et al: The value of aggressive therapy in the hypertensive patient with azotemia. Circulation 60:893-904, 1969.Crossref 13. Millar WE, et al: Management of severe hypertension with intravenous injections of diazoxide. Am J Cardiol 24:870-875, 1969.Crossref 14. Limas CJ, Freis ED: Minioxidil in severe hypertension in renal failure. Am J Cardiol 31:355-361, 1973.Crossref 15. Pettinger WA, Mitchell HC: Minioxidil: An alternative to nephrectomy for refractory hypertension. N Engl J Med 289:167-171, 1973.Crossref 16. Sevitt LH, et al: Acute oliguric renal failure due to accelerated (malignant) hypertension. Q J Med 157:127-144, 1971. 17. Kincaid-Smith P, et al: Clinical course and pathology of hypertension with papilledema (malignant hypertension). Q J Med 26:117-163, 1958. 18. Perry HM, et al: Studies on the control of hypertension: VIII. Mortality, morbidity and remissions during 12 years of intensive therapy. Circulation 33:958-972, 1966.Crossref 19. Breckenridge A, et al: Prognosis of treated hypertension. Q J Med 39:411-429, 1970. 20. Page IH: Medical aspects of surgical treatment of hypertension. JAMA 110:1161-1165, 1938.Crossref 21. McCormack LJ, et al: Effect of antihypertensive treatment on the evolution of the renal lesions in malignant hypertension. Am J Pathol 34:1011-1021, 1958. 22. Harington M, et al: Results of treatment in malignant hypertension. Br Med J 2:969-980, 1959.Crossref 23. Mundth ED, et al: Correction of malignant hypertension and return of renal function following late renal embolectomy. Am J Med 46:985-988, 1969.Crossref 24. Eknoyan G, Siegel MB: Recovery from anuria due to malignant hyperten sion. JAMA 215:1122-1126, 1971.Crossref 25. Pickering GW, et al: The reversibility of malignant hypertension. Lancet 2:952, 1952.Crossref 26. Rossman PL, Winer JH: Malignant renal hypertension. Arch Intern Med 108:588-593, 1961.Crossref 27. Allison PR, et al: The production and resolution of hypertensive vascular lesions in the rabbit. Clin Sci 33:39-51, 1967. 28. Bennett AH, Lazarus JM: Bilateral nephrectomy performed on an emergency basis for life-threatening malignant hypertension. Surg Gynecol Obstet 137:451-452, 1973. 29. De Palma JR, Abukurah A: Androgen therapy in hemodialysis patients. Proc Dialysis Transplant Forum 2:123-124, 1972. 30. De Luca HF: Regulation of functional vitamin D metabolism: A new dimension in calcium homeostasis , in Cornell Seminars in Nephrology . New York, John Wiley & Sons, 1973, pp 47-71.
Archives of Internal Medicine – American Medical Association
Published: Feb 1, 1975