Renal sympathetic denervation in treating drug-resistant hypertension in a patient on hemodialysis

A 26-year-old man had an end-stage renal disease because of a neurogenic urinary bladder with a vesicourinary reflux. The first kidney transplant was lost in consequence of chronic allograft nephropathy. Immunosuppressive medication was withdrawn and transplantectomy was performed in November 2010. After transplantectomy, his blood pressure (BP) slowly increased up to 200/100 mmHg. Antihypertensive medication was intensified and a fluid overload was excluded with body composition bioimpedance measurements. Forty-eight-hour ambulatory BP was 180/109 mmHg in the daytime and 178/108 mmHg in the night-time. Bilateral renal denervation (RDN) was performed with a single electrode Symplicity catheter on May 2013. The effect of RDN became evident at the 6 months visit, and all the antihypertensive medicines were withdrawn at 12 months. Fifteen months after RDN, 48-h ambulatory BP was 120/63 mmHg in the daytime and 108/60 mmHg in the night-time. The patient was without antihypertensive medication until retransplantation in May 2015.