Urgent Bilateral Nephrectomy for Severe Hypertension

Eight hemodialysis patients with severe hypertension resistant to maximum reduction in extracellular volume underwent emergency bilateral nephrectomy to reverse complications of intractable heart failure, encephalopathy, and papilledema. Nephrectomy resulted in prompt reduction of blood pressure and resolution of complications, with low morbidity and no mortality. One patient with grade IV retinopathy had permanent optic nerve damage despite lower blood pressure after nephrectomy. Subsequently, resistant hypertension with decreasing vision was indication for immediate nephrectomy. Other indications for early bilateral nephrectomy and the treatment of these critically ill patients in the paraoperative period are discussed. Several months after nephrectomy three patients with "dry weight" again developed hypertension, but of a considerably more benign nature. The prompt improvement and smoother course of these patients lead us to suggest that bilateral nephrectomy should be considered earlier than previously recommended for dialysis patients with malignant hypertension.