What is the role of nephrectomy in the treatment of renovascular hypertension (RVHT)?

Updated: Dec 01, 2020
  • Author: Rebecca J Schmidt, DO, FACP, FASN; Chief Editor: Vecihi Batuman, MD, FASN  more...
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Answer

As noted, the goal of therapy for RVHT is to resolve systemic hypertension without compromising renal function. Nephrectomy should be considered a last resort in the treatment of RVHT.

Because renovascular disease is often bilateral, with the contralateral renal system occasionally not affected until years later, it is always best to keep both kidneys functioning whenever possible. However, in cases of severe renal hypoplasia that reduces functional capacity to less than 10% of total renal function, removal of the kidney is the best form of treatment. [57]

Nephrectomy may be necessary if complications arise during surgical revascularization or if the disease is too widespread (especially in segmental arteries) to be effectively bypassed. Children whose hypertension is refractory to the previously mentioned forms of treatment may also need nephrectomy to correct their high blood pressure. [55, 58]


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