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Treatment With Hemodialysis and Nephrectomy

J. Michael Lazarus, MD; Constantine L. Hampers, MD; John P. Merrill, MD

Arch Intern Med. 1974;133(6):1059-1066.

Abstract
Hypertension is a frequent and early component in the uremic syndrome. Extracellular volume expansion causes hypertension in approximately 75% of patients with chronic renal failure and therefore is responsive to hemodialysis. The other major cause of hypertension in uremic patients is hyperreninemia. The degree of hypertension in this small group of patients is more extreme, is not responsive to volume manipulations by dialysis, and often will require bilateral nephrectomy. The route of excretion and drug-dosage alteration in hypertension treatment before initiation of dialysis are important. Indications for hemodialysis and bilateral nephrectomy for complicated hypertension and in preparation for renal transplantation vary in different programs. The increased incidence of cardiovascular death in chronic hemodialysis patients should modify these indications to obtain earlier and better control of hypertension.

Author Affiliations
Boston

From the Department of Medicine, Peter Bent Brigham Hospital, Boston.

Footnotes
Received for publication Oct 23,1973; accepted Jan 28, 1974.

Reprint requests to 721 Huntington Ave, Boston, MA 02115 (Dr. Lazarus).

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