Hypertension in Unilateral Atrophic Kidney Secondary to Ureteropelvic Junction Obstruction

Abstract

A patient with atrophic unilateral hydronephrosis due to ureteropelvic junction obstruction associated with hypertension was successfully treated by nephrectomy. Preoperatively, plasma renin activity was elevated in both the peripheral vein and affected renal vein. Renin concentration in the resected kidney was high, and immunohistochemical localization of renin was observed along the afferent arterioles of the juxtaglomerular apparatus and in arterioles at some distance from the glomeruli.

Hypertension and Hydronephrosis: Rapid Resolution of High Blood Pressure Following Relief of Bilateral Ureteric Obstruction

“…Secondary hypertension occurring as a consequence of hydronephrosis has been described in a small number of animal models 1 and clinical reports. [2][3][4][5] Interestingly, based upon the limited number of cases, unilateral hydronephrosis appears to be sufficient to cause hypertension. 2,4,5 The presence of a normal contralateral kidney may not be adequate to mitigate the effect of the hydronephrosis.…”

“…[2][3][4][5] Interestingly, based upon the limited number of cases, unilateral hydronephrosis appears to be sufficient to cause hypertension. 2,4,5 The presence of a normal contralateral kidney may not be adequate to mitigate the effect of the hydronephrosis. Some authors describe resolution of hypertension following removal of the affected kidney, 5 while others show that relief of obstruction may also lead to normalisation of blood pressure.…”

“…2,4,5 The presence of a normal contralateral kidney may not be adequate to mitigate the effect of the hydronephrosis. Some authors describe resolution of hypertension following removal of the affected kidney, 5 while others show that relief of obstruction may also lead to normalisation of blood pressure. 2,3 It therefore appears that the intra-renal mechanism leading to the pressor effect is reversible.…”

“…In animal studies and clinical reports on hydronephrosis, peripheral plasma renin activity has been shown to be elevated. 1,2,5 In cases of hypertension and unilateral hydronephrosis, selective renal vein sampling generally shows elevated renin secretion from the affected kidney and suppressed levels from the contralateral side. 5 High preoperative plasma renin levels are predictive of improvement in blood pressure following surgery in hypertensive hydronephrotic patients.…”

“…1,2,5 In cases of hypertension and unilateral hydronephrosis, selective renal vein sampling generally shows elevated renin secretion from the affected kidney and suppressed levels from the contralateral side. 5 High preoperative plasma renin levels are predictive of improvement in blood pressure following surgery in hypertensive hydronephrotic patients. 4 The cause for the increased activity of the RAA axis that occurs in hydronephrotic kidneys is unclear, but may, in part, be a consequence of the reduced renal blood flow that occurs as a result of the heightened TGF.…”