Hypertension is common in renal transplant patients and sometimes very difficult to control. Refractory
hypertension can adversely affect renal graft and patient survival. Many
antihypertensive medications are not well tolerated or can have important drug interactions with immunosuppressive medications. These drugs can cause significant side effects including fluid depletion,
azotemia,
electrolyte imbalance, and
anemia. Bilateral native
nephrectomy in renal transplant patients has been reported to be beneficial in controlling severe
hypertension. We report five patients with severe
hypertension despite as many as 9 different
antihypertensive medications. All patients had previous kidney or simultaneous kidney
pancreas transplantation. Each of our patients underwent laparoscopic bilateral native
nephrectomy. Renal function varied from
creatinine of 1.4-2.4, and the number of
antihypertensive medications from 3 to 9 at the time of
nephrectomy surgery. Mean arterial blood pressure improved in all five patients at 3-6 months post
nephrectomy, the number of
antihypertensive medications decreased in 4, but renal function remained stable at 3-6 months in only 3 patients. We found laparoscopic bilateral native
nephrectomy to be beneficial in renal and simultaneous kidney pancreas transplant patients with severe and refractory
hypertension. Our patients with better baseline renal allograft function at time of
nephrectomy received the most benefit. No decrease in allograft function could be attributed to acute rejection.