Schwarz E R, Heintz B, Stefanidis I, vom Dahl J, Sieberth H G
Medical Clinic I, University Hospital, RWTH Aachen, Germany.
Ren Fail. 2000;22(5):591-604. doi: 10.1081/jdi-100100900.
Controversy exists about the time course of blood pressure normalization following bilateral nephrectomy. We sought to evaluate the time course of blood pressure normalization following bilateral nephrectomy and after subsequent kidney transplantation.
Clinical data from 14 hypertensive patients were retrospectively assessed. Baseline blood pressure was 175 +/- 33/109 +/- 9 mmHg. Ten patients firstly underwent unilateral nephrectomy, which resulted in a slight increase of blood pressure (185 +/- 22/110 +/- 5 mmHg). One month following bilateral nephrectomy, blood pressure was 167 +/- 23/104 +/- 17 mmHg, at 3 months 159 +/- 42/104 +/- 25 mmHg, and at 6 months 149 +/- 41/96 +/- 30 mmHg. Antihypertensive medication was necessary in 9/14 patients at a 2 year follow-up. Eight patients remained anephric (group I), 6 patients had subsequent kidney transplantation (group II). In group I, blood pressure was 159 +/- 42/93 +/- 17 mmHg and 129 +/- 34/75 +/- 14 mmHg at 3 and 6 months, respectively (p< 0.05 vs. baseline). In group II, blood pressure decreased from 188 +/- 42/ 128 +/- 46 mmHg to 167 +/- 48/113 +/- 32 mmHg at 3 months, but increased after transplantation to 186 +/- 39/118 +/- 33 mmHg. Antihypertensive medication was still necessary in 5 transplanted patients (83%) and in 3 anephric patients (38%).
Adaptation of the blood pressure response following bilateral nephrectomy is a time requiring process, and long-term antihypertensive medication may still be necessary.
双侧肾切除术后血压恢复正常的时间进程存在争议。我们试图评估双侧肾切除术后及后续肾移植后血压恢复正常的时间进程。
对14例高血压患者的临床资料进行回顾性评估。基线血压为175±33/109±9 mmHg。10例患者首先接受了单侧肾切除术，这导致血压略有升高（185±22/110±5 mmHg）。双侧肾切除术后1个月，血压为167±23/104±17 mmHg，3个月时为159±42/104±25 mmHg，6个月时为149±41/96±30 mmHg。在2年随访时，14例患者中有9例需要服用降压药。8例患者仍无肾（I组），6例患者随后接受了肾移植（II组）。在I组中，3个月和6个月时血压分别为159±42/93±17 mmHg和129±34/75±14 mmHg（与基线相比，p<0.05）。在II组中，3个月时血压从188±42/128±46 mmHg降至167±48/113±32 mmHg，但移植后升高至186±39/118±33 mmHg。5例移植患者（83%）和3例无肾患者（38%）仍需要服用降压药。
双侧肾切除术后血压反应的适应是一个需要时间的过程，长期服用降压药可能仍然必要。
