The Effect on the Kidney of Bilateral Splanchnicectomy in Patients With Hypertension

Abstract

Recently there has been a renewed interest in the etiology and treatment of hypertension (hypertensive vascular disease) and its relationship to the kidneys. A surgical method of treatment of hypertension which was devised by Peet (1) consists of a bilateral resectioning of the major and minor splanchnic nerves and of the lower dorsal sympathetic chain including the 10th, 11th and 12th ganglia, supradiaphragmatically. This procedure has been employed in a sufficient number of cases so that the trend of results is indicated. It is the purpose of this communication to report the effect of this operation upon the kidneys, as it is shown by measurement of renal function and urinary abnormalities, and to correlate this effect with the blood pressure changes. Considerations of the rationale behind this treatment of hypertension, selection of candidates, technical procedure, and results other than the renal effect will not be discussed. METHOD OF STUDYEvery candidate for this operation was carefully studied in order to exclude all cases having hypertension secondary to known organic disease. Special care was taken to exclude those patients with hemorrhagic (glomerular) nephritis having elevated blood pressure. As a result only cases considered to have primary (" arterial ") hypertension (hypertensive vascular disease), were treated by splanchnicectomy. This report includes observations on only those patients whom we have studied over a period of three months, or longer, after operation.Before, and at intervals after this operation, blood pressure and renal function were measured, and the urine was analyzed. The blood pressure was in every case measured with a mer.-cury manometer several times while the patient was lying down. Renal function was measured by the urea clearance test of Van Slyke and Cope (2) and by the Lashmet-Newburgh concentration test (3). Proteinuria was measured by sulphosalicylic acid precipitation (4), and the formed elements in the urinary sediment were counted by the Addis method (5).Criteria for classification. We have adopted the normal values found by the originators of the tests of renal function, i.e., for the concentration test a nonprotein specific gravity of the urine of 1.029 or more, and for the urea clearance, values between 75 and 125 per cent of the mean normal. The renal function was considered to be impaired when the result of either of the functional tests was below normal. A significant change in renal function was considered to consist of a change in specific gravity of 0.003 or more, or a change of 15 per cent or more in urea clearance.It is always difficult to discuss changes in blood pressure because of the fluctuations encountered. For the purpose of classification, we have grouped the patients according to the change in blood pressure following splanchnicectomy as follows: 1, those whose blood pressure was reduced to 160/100 mm. Hg, or less; 2, those whose blood pressures did not remain below 160/100, but whose systolic blood pressure was reduced more than 60 mm. Hg, or who...

The Effect of High Spinal Anesthesia on the Renal Hemodynamics and the Excretion of Electrolytes During Osmotic Diuresis in the Hydropenic Normal Pregnant Woman 1

“…Renal function has been studied in patients with essential hypertension following lumbodorsal sympathectomy, spinal anesthesia and renal denervation (17)(18)(19)(20)(21)(22)(23). The results have varied according to the nature of the procedure and experimental conditions.…”

Health-Related Quality of Life After Renal Denervation in Patients With Treatment-Resistant Hypertension

“…Although blood pressure reduction in response to surgical sympathectomy was encouraging, it should be noted that responses were variable and interventions were not without complications. Freyberg and Peet 4 reported a significant blood pressure reduction of ≈30/15 mm Hg ≥3 months after bilateral splanchnicectomy. Reports by Hoobler et al 5 and Smithwick and Thompson 6 noted a fall in blood pressure in 29% to 45% of patients 1 to 5 years postsympathectomy.…”

“…Reports by Hoobler et al 5 and Smithwick and Thompson 6 noted a fall in blood pressure in 29% to 45% of patients 1 to 5 years postsympathectomy. These early studies, although principally dedicated to surgical development, blood pressure reduction, and mortality, also noted that benefits associated with sympathetic denervation may extend to improvement in renal function 4,7 and cardiac structure. 5 Similar findings have now been reported for renal denervation achieved using a catheter-based approach without significant side effects.…”

Blood pressure and neurohormonal responses to renal nerve ablation in treatment-resistant hypertension

“…S urgical renal sympathetic denervation has been applied in the first part of the past century for the treatment of patients with severe or malignant hypertension [1][2][3]. Although the procedure was effective in a substantial proportion of patients, it was abandoned because of its invasiveness, procedural complications, postoperative adverse effects and the introduction of effective blood pressure (BP)-lowering drugs.…”