Denervation of three equivalent right renal arteries in a patient with resistant hypertension after left-sided nephrectomy: five-year follow-up

In the majority of patients with resistant hypertension, increased activity of the sympathetic system is observed. Denervation of renal arteries (RDN) is one of the methods that may lead to reduction of blood pressure [1, 2]. Although the ESC/ESH guidelines do not recommend using invasive methods in the routine treatment of hypertension, current Polish Society for Hypertension guidelines published after the SPYRAL and RADIANCE trial publications emphasise the effectiveness and benefits of this form of treatment [3, 4]. Currently, it is recommended that RDN is classified and performed only in highly specialised centres [3, 4].
A 62-year-old patient was admitted because of increased values of blood pressure (average blood pressure (BP) 170/100 mm Hg) despite taking five antihypertensive drugs in maximum doses: carvedilol, doxazosin, valsartan, hydrochlorothiazide, and nitrendipine. The patient’s history included: left-sided nephrectomy because of renal cell carcinoma (15.03.2000), two strokes, type 2 diabetes, and obesity (body mass index (BMI) 45 kg/m2). The reasons of secondary hypertension were excluded. Ambulatory blood pressure monitoring (ABPM) confirmed inappropriate control of BP (average 172/96 mm Hg: day average 179/102 mm Hg, night average 156/83 mm Hg). An angio-computed tomography (CT) scan revealed three separate, equivalent arteries supplying blood to the right kidney (Figures 1 I, II). The arteries ran parallel in the proximal and medial parts (the upper artery – length 83 mm, diameter 4.5 mm, the lower 85 mm and 4.3 mm, the medial 110 mm and 4.0 mm, respectively). The patient was qualified for RDN. The denervation was performed in three right arteries with the use of a multielectrode catheter EnligHTNTM (St. Jude Medical). In every artery two radiofrequency applications were done (eight ablation points altogether) (Figure 1 III).
The pharmacological treatment was maintained throughout the follow-up period. During control visits after 1 and 6 months the patient had satisfactory control of BP (mean BP 136/77 mm Hg, 124/65 mm Hg, respectively), and no episodes of hypotension were observed nor biochemical features of deterioration of kidney function. Seven months after RDN the patient was admitted to the hospital because of a collapse. Low BP values were found on admission (90/45 mm Hg); biochemical test results showed no abnormalities. ABPM revealed low BP values (day 105/56 mm Hg, night 111/59 mm Hg). The doses of...


View full text...