Revisiting the role of nephrectomy for advanced XXXX .

@entity1 @entity8 @entity455 @entity101 @entity731
BACKGROUND: Despite the advances in antihypertensive therapy and renal revascularization, there remains a group of @entity1 in whom @entity455 leads to @entity8 and treatment-resistant @entity101 . METHODS: We performed an observational cohort study in which we reviewed blood pressures, renal function, and predictors of response in 74 @entity1 who underwent nephrectomy of a small kidney for uncontrolled @entity101 between 1990 and 2000. RESULTS: The median age of the @entity1 was 65 years; 43 (58%) were @entity1 . Thirty-five @entity1 (47%) underwent nephrectomy as part of combined revascularization of the contralateral kidney. Associated @entity731 were common (28% to 49%), as were prior renal revascularization (21 [28%]) and @entity101 urgency/emergencies (23 [31%]). The mean (+/- SD) long axis of the affected kidney was 8 +/- 2 cm, and the mean function of the kidney (based on radioisotope renography) was 12% +/- 11% of total renal function. The average systolic blood pressure fell from 168 +/- 19 mm Hg to 136 +/- 18 mm Hg (P <0.0001) and diastolic blood pressure declined from 88 +/- 10 mm Hg to 76 +/- 9 mm Hg (P <0.0001) at the most recent available clinic visit (mean follow-up, 4.1 +/- 2.6 years). In addition, the number of antihypertensive medications decreased from 3.2 +/- 1.1 to 2.2 +/- 1.5 (P <0.0001). Renal function remained stable. Results were similar (preoperative blood pressure of 165/88 mm Hg taking three medications to 137/77 mm Hg taking two medications) among the 39 @entity1 who had a nephrectomy without contralateral revascularization. CONCLUSION: Our results suggest that in selected @entity1 with resistant @entity101 and @entity8 that has resulted in @entity8 with reduced function, nephrectomy can improve blood pressure control without further loss in overall renal function.
