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.

中文翻译：

---

患有 5 期慢性肾病的儿童严重高血压的双侧自体肾切除术导致移植后血压控制得到改善。

背景

高血压是 5 期慢性肾病 (CKD 5) 和肾移植 (KT) 后的常见问题。关于 CKD 5 岁儿童接受双侧自体肾切除术 (BNN) 治疗高血压的结果的数据有限。

方法

对 134 名在单一中心接受 KT 治疗超过 10 年且至少随访 1 年的儿童的回顾性研究。确定了在 KT 之前和之后接受过 BNN 治疗高血压的儿童，并将他们在血压 (BP)、抗高血压药物和移植物功能方面的结果与其他队列进行比较。

结果

11 名儿童 (8.2%) 接受了 BNN，其中 2 名在 KT 后进行，原因是尽管服用了 3 种抗高血压药物，但血压控制不佳。BNN 的中位年龄为 7 岁（范围 0.5-17 岁）。在 KT 之前接受 BNN 治疗的所有 9 名儿童在中位 6 个月后停止使用抗高血压药物，并在 KT 后保持正常血压。在 KT 后平均随访 5 年后，与队列中的其他人相比，接受 BNN 治疗的儿童的高血压患病率有降低的趋势（9.1% 对 25%，p = 0.23）。接受 BNN 治疗的儿童均无任何蛋白尿迹象，KT 后 eGFR 中位数为 74 ml/min/1.73 m 2。

结论

CKD 5 重度高血压的 BNN 与 KT 前高血压的消退有关。它还与 KT 后高血压患病率降低和移植物功能良好的趋势相关。