16 May 2018 : Case report
Reduction of Blood Pressure Following After Renal Artery Adventitia Stripping During Total Nephroureterectomy: Potential Effect of Renal Sympathetic Denervation
Unusual or unexpected effect of treatmentKeisuke Okamura1DEF*, Shunsuke Satou12DEF, Keita Setojima2DE, Shinjiro Shono3DE, Shigero Miyajima4DE, Tatsu Ishii4DE, Kazuyuki Shirai1DE, Hidenori Urata1DE
Am J Case Rep 2018; 19:567-572
BACKGROUND: Catheter-based renal sympathetic denervation has been reported to be effective for treatment resistance hypertension in Australia and Europe. However, in the blinded SYMPLICITY HTN-3 trial, renal denervation did not achieve a significant decrease in blood pressure (BP) in comparison to sham controls. There have been various discussions on the factors that influenced this result.
CASE REPORT: Two men on antihypertensive therapy underwent unilateral radical nephroureterectomy for cancer of the renal pelvis. When the renal artery adventitia was stripped and cauterized just before renal artery ligation, the measured BP of the 2 men increased after stripping adventitia and decreased gradually after cauterization of the renal artery. This was presumably due to removal of renal artery sympathetic nerves, similar to the mechanism of catheter-based renal sympathetic denervation, although anesthesia, fluid infusion, and/or mesenteric traction may have had an influence.
CONCLUSIONS: A similar strategy involving thoracolumbar sympathectomy was reported about 50 years ago. The clinically significant blood pressure reduction in these patients suggests renal denervation is effective.
Keywords: Hypertension, Nephrectomy, Sympathectomy
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