A case of
renal hypertension after pyelolithotomy cured by segmental
nephrectomy is reported. The patient, a 39-year-old man had had pyelolithotomy performed by the lumbodorsal approach at another hospital. Two months after operation he started to complain of
headache and palpitation. The blood pressure was markedly high when he visited our hospital and peripheral plasma
renin activity was also elevated. Urinalysis was normal except for slight
proteinuria. The excretory urogram demonstrated cortical
scarring in the lower portion of the left kidney. The renal scintigram demonstrated low uptake in this area, suggesting renal
infarction. Renal arteriogram showed decreased vascularity in this area. Plasma
renin activity was measured on the blood drawn from the renal vein of both sides and the ratio was about 2.4, and
renin activity of the segmental renal vein from the left lower portion was elevated. Segmental
nephrectomy of the lower pole was performed. The blood pressure three weeks after lower pole resection was estimated to be normal and
renin activity returned to an almost normal level. Discussion was made on the cause of
renal hypertension after renal surgery. In this case, it was suggested that
renal hypertension is caused by subinfraction due to lesions of the dorsal renal artery in surgery for
renal calculus.