Bilateral native nephrectomies for severe hypertension in children with stage 5 chronic kidney disease leads to improved
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BRIEF REPORT
Bilateral native nephrectomies for severe hypertension in children with stage 5 chronic kidney disease leads to improved BP control following transplantation Charles Pickles 1 Mohan Shenoy 1
&
Amrit Kaur 1 & Dean Wallace 1 & Christian Brix 1 & Rachel Lennon 1,2 & Nicholas Plant 1 &
Received: 1 March 2020 / Revised: 21 July 2020 / Accepted: 4 August 2020 # IPNA 2020
Abstract Background Hypertension is a common problem in stage 5 chronic kidney disease (CKD 5) and following kidney transplantation (KT). There is limited data on the outcome of children with CKD 5 who undergo bilateral native nephrectomies (BNN) for the management of hypertension. Method Retrospective review of 134 children who underwent KT at a single centre over a 10-year period and had a minimum follow up period of 1 year. Children who had undergone BNN for hypertension prior to, and after, KT were identified and their outcome with regard to blood pressure (BP), anti-hypertensive medications and graft function was compared with that of the rest of the cohort. Results Eleven children (8.2%) underwent BNN, including 2 performed after KT, due to poorly controlled BP despite a median of 3 anti-hypertensive medications. The median age at BNN was 7 years (range 0.5–17 years). All 9 children who underwent BNN prior to KT discontinued anti-hypertensive medication after a median of 6 months and remained normotensive post KT. After a median follow up of 5 years following KT, there was a trend towards lower prevalence of hypertension in children who underwent BNN compared with that of the rest of the cohort (9.1% vs 25%, p 0.23). None of the children who underwent BNN had any evidence of proteinuria, and the median eGFR was 74 ml/min/1.73 m 2 after KT. Conclusion BNN for severe hypertension in CKD 5 is associated with resolution of hypertension prior to KT. It is also associated with a trend towards lower prevalence of hypertension and good graft function following KT. Keywords Hypertension, Bilateral native nephrectomies, Stage 5 chronic kidney disease, Kidney transplant, Children
Introduction Hypertension is a common problem in stage 5 chronic kidney disease (CKD 5). Following kidney transplantation (KT), hypertension continues to be a significant issue with observational studies reporting a prevalence of 22–89% [1]. A large UK registry study showed that the prevalence of hypertension increased from 28% at the time of KT to almost 50% at 2 years following KT [2]. Deceased donor transplant, short stature and hypertension prior to KT were risk factors for developing * Mohan Shenoy [email protected] 1
Department of Paediatric Nephrology, Royal Manchester Children’s Hospital, Oxford Road, Manchester M13 9WL, UK
2
Wellcome Centre for Cell-Matrix Research, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
hypertension following KT [2, 3], which is associated with reduced graft function and survival [3, 4]. Children undergoing bilateral native nephrectomies (BNN) have been reported to need fewer anti-hyper
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