Why the study?
Does nephrectomy improve blood pressure and proteinuria in a patient with renovascular hypertension and unilateral focal segmental glomerulosclerosis?
Does nephrectomy improve blood pressure and proteinuria in a patient with renovascular hypertension and unilateral focal segmental glomerulosclerosis?
Nephrectomy successfully normalized blood pressure and reduced proteinuria in a patient with renovascular hypertension and contralateral focal segmental glomerulosclerosis.
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Should not yet change practice in renovascular hypertension with FSGS; hypothesis-generating and requires prospective confirmation.
A 48-year-old man presented with malignant hypertension and massive proteinuria. Renal angiography showed complete obstruction of the left renal artery and 99mTc-mercaptoacetylglycine (MAG3) renography showed a nonfunctioning left kidney. Percutaneous transluminal renal angioplasty of the left renal artery was unsuccessful; hence, the patient underwent left nephrectomy because of uncontrolled hypertension and proteinuria. Histological examination of a right kidney specimen revealed lesions of focal segmental glomerulosclerosis with benign nephrosclerosis. In contrast, histology of the left kidney showed typical ischemic kidney with hypertrophy of arteriolar smooth muscle cells. The patient responded favorably to the nephrectomy, as his blood pressure and urinary protein dramatically decreased with no antihypertensive medication. This case illustrates the heterogeneous effect of the renin-angiotensin system on either kidney in patients with renovascular hypertension due to unilateral renal artery stenosis.
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Alchi et al. (2006) studied this question.
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