Bilateral native nephrectomies for severe hypertension in children with stage 5 chronic kidney disease leads to improved BP control following transplantation

Background Hypertension is a common problem in stage 5 chronic kidney disease (CKD 5) and following kidney transplantation (KT). There is limited data on the outcome of children with CKD 5 who undergo bilateral native nephrectomies (BNN) for the management of hypertension. Method Retrospective review of 134 children who underwent KT at a single centre over a 10-year period and had a minimum follow up period of 1 year. Children who had undergone BNN for hypertension prior to, and after, KT were identified and their outcome with regard to blood pressure (BP), anti-hypertensive medications and graft function was compared with that of the rest of the cohort. Results Eleven children (8.2%) underwent BNN, including 2 performed after KT, due to poorly controlled BP despite a median of 3 anti-hypertensive medications. The median age at BNN was 7 years (range 0.5-17 years). All 9 children who underwent BNN prior to KT discontinued anti-hypertensive medication after a median of 6 months and remained normotensive post KT. After a median follow up of 5 years following KT, there was a trend towards lower prevalence of hypertension in children who underwent BNN compared with that of the rest of the cohort (9.1% vs 25%, p 0.23). None of the children who underwent BNN had any evidence of proteinuria, and the median eGFR was 74 ml/min/1.73 m 2 after KT. Conclusion BNN for severe hypertension in CKD 5 is associated with resolution of hypertension prior to KT. It is also associated with a trend towards lower prevalence of hypertension and good graft function following KT.