Malignant Hypertension: Kidneys Too Good to be Extirpated

The grave prognosis associated with malignant hypertension and renal failure has stimulated the search for effective modes of therapy. Evidence that the renal arteriolitis associated with malignant hypertension is the result of the elevated blood pressure—not the cause—has led to the aggressive medical therapy of this disorder. Several reports have detailed the improvement in renal function after adequate reduction of elevated arterial pressure in azotemic, malignant hypertension. In addition to medical therapy, bilateral nephrectomy has been shown to be of value in the reduction of arterial pressure in selected patients with hyperreninemic, nonvolume-dependent hypertension with terminal renal failure. In order to prevent needless nephrectomies and the many problems associated with chronic dialysis, there appears to be no justifiable circumstance to recommend bilateral nephrectomy as an emergency procedure.