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Nephrectomy improves both antihypertensive requirement and left ventricular mass for pediatric renal hypertension

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Abstract

Background

Renal hypertension causes left ventricular (LV) hypertrophy leading to cardiomyopathy. Nephrectomy has been utilized to improve blood pressure and prepare for kidney transplantation in the pediatric population. We sought to investigate antihypertensive medication (AHM) requirement and LV mass in patients undergoing nephrectomy with renal hypertension.

Methods

We performed a single institution retrospective review from 2009 to 2021 of children who have undergone nephrectomy for hypertension. Primary outcome was decrease in number of AHM. Secondary outcomes included change in LV mass and elimination of AHM. LV mass was measured using echocardiogram area-length and linear measurements. Non-parametric analyses were utilized to assess significance.

Results

Thirty-one patients underwent nephrectomy. Median age was 12.5 years (0.8–19 years). Median of 3 AHM (range 1–5 medications) were used pre-operatively and patients had been managed for median 2.5 years. Twenty-nine had preoperative echocardiogram. Forty-eight percent of patients had LVH at nephrectomy. Median AHM after surgery was 1 (range 0–4 medications) at 30 days and 12 months, (p < 0.001). By 12 months after nephrectomy, 79.2% of patients had decreased the number of AHM. Eight (26%) patients were on no AHM 30 days after surgery, and 13 (43%) at 12 months. Systemic vascular disease and multicystic dysplastic kidney were the only factors associated with lack of improvement in AHM (p = 0.040). Fourteen patients had pre- and post-operative echocardiogram and 11 (79%) had improvement in LV mass (p = 0.016, 0.035).

Conclusions

Nephrectomy is effective in improving LV mass and reducing AHM for children with renal hypertension. Improvement is less likely in patients with systemic vascular disease and multicystic dysplastic kidneys.

Graphical abstract

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Data availability

The HIPAA compliant datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Author information

Authors and Affiliations

  1. University of California - San Diego, 200 West Arbor Drive MC 7897, San Diego, CA, 92103, USA

    Laura B. Cornwell, Andres Moreno Rojas, Ian Golding, Sarah Marietti & Elizabeth G. Ingulli

  2. Rady Children’s Hospital – San Diego, 3020 Childrens Way MC 5120, San Diego, CA, 92123, USA

    Laura B. Cornwell, Andres Moreno Rojas, Ian Golding, Sarah Marietti & Elizabeth G. Ingulli

  3. Norton Children’s Hospital, 231 E Chestnut St, Louisville, KY, 40202, USA

    Laura B. Cornwell

  4. University of Louisville School of Medicine, 500 S Preston St, Louisville, KY, 40202, USA

    Laura B. Cornwell

  5. University of Colorado School of Medicine, 13001 E 17Th Pl, Aurora, CO, 80045, USA

    Eniola Ogundipe

Authors
  1. Laura B. Cornwell
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  2. Andres Moreno Rojas
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  3. Eniola Ogundipe
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  4. Ian Golding
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  5. Sarah Marietti
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  6. Elizabeth G. Ingulli
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Contributions

All authors contributed to the study conception and design.

Conceptualization: S Marietti and E Ingulli.

Methodology: S Marietti, E Ingulli, I Golding.

Material preparation, data collection was performed by L Cornwell, A Moreno Rojas and E Ingulli.

Analysis was performed by L Cornwell and E Ingulli.

The first draft of the manuscript was written by combined work from L Cornwell, A Moreno Rojas, and E Ogundipe and all authors commented on previous versions of the manuscript.

All authors read and approved the final manuscript.

Corresponding author

Correspondence to Laura B. Cornwell.

Ethics declarations

Ethics approval

This research study was conducted retrospectively from data obtained for clinical purposes. This study was supported by an Institutional Review Board (IRB) exemption from Rady Children’s hospital IRB, # 161585.

Conflict of interest

The authors declare no competing interests.

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Electronic supplementary material

Below is the link to the electronic supplementary material.

Graphical Abstract (PPTX 65 KB)

Supplementary file2 (PDF 421 KB)

Appendix 1

Appendix 1

Nephrectomy procedure codes:

554

555

5551

5552

5553

5554

50546

50545

50543

50548

50220

50225

50234

50336

50240

Hypertension diagnosis codes:

401 ESSENTIAL HYPERTENSION*

4010 MALIGNANT HYPERTENSION

4011 BENIGN HYPERTENSION

4019 HYPERTENSION NOS

405 SECONDARY HYPERTENSION*

4050 MAL SECOND HYPERTENSION*

4059 SECOND HYPERTENSION NOS*

40591 RENOVASC HYPERTENSION

40599 SECOND HYPERTENSION NEC

4010 MALIGNANT HYPERTENSION

4010Z MALIGNANT HYPERTENSION

4011 BENIGN HYPERTENSION

4011Z BENIGN HYPERTENSION

4019 ESSENTIAL HYPERTENSION, UNSPECIFIED

4019Z ESSENTIAL HYPERTENSION, UNSPECIFIED

401Z ESSENTIAL HYPERTENSION

I150 RENOVASCULAR HYPERTENSION

I158 OTHER SECONDARY HYPERTENSION

I10 ESSENTIAL (PRIMARY) HYPERTENSION

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Cornwell, L.B., Rojas, A.M., Ogundipe, E. et al. Nephrectomy improves both antihypertensive requirement and left ventricular mass for pediatric renal hypertension. Pediatr Nephrol 38, 2147–2153 (2023). https://doi.org/10.1007/s00467-022-05854-1

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