A CASE OF TRANSIENT RENOVASCULAR HYPERTENSION FOLLOWING NEPHROLITHOTOMY
1981 Volume 72 Issue 9 Pages 1200-1207
Details
1981 Volume 72 Issue 9 Pages 1200-1207
A case of transient renovascular hypertention after nephrolithotomy was reported. The patient, a 51-year-old male, was diagnosed as having a right staghorn calculus. His preoperative blood pressure was 120/66mmHg. Nephrolithotomy was undertaken by the method of one-layer interrupted parenchymal suture.
It took 28 minutes to clamp the renal pedicle. The blood loss during the operation amounted to only 300cc without requiring blood transfusion. While the right kidney had no accessory artery nor aberrant vessels, the renal pedicle was accidentally twisted by nearly 180° at the time of occluding the blood flow.
Macroscopic hematuria in the postoperative period continued for only 3 days, but hypertension was observed on the night of operation. On the 4th day after operation the blood pressure rose to 224/130mmHg, showing a high plasma renin activity of 7.8ng/ml/hr (normal value is 0.5-2.0). After administration of Aldomet, the blood pressure and renin activity returned to normal, and the antihypertensive drug was discontinued.
Drip infusion pyelography (DIP) 15 days after operation showed only a very slight image of the right renalcalyces and a pattern of renogram was compatible with functional disturbance in the right kidney. RI-angiography demonstrated a decrease of the right renal blood flow. Excretory urography 24 days after operation revealed good renal function and calyectasis improved. In the CT scanning a small zone of scar was observed along the site of incision of the right renal parenchyma.
The patient was discharged 33 days after the operation and thereafter his condition improved to the extent that he could assume his occupational responsibilities. The blood pressure 8 months after operation was estimated to be normal and the right renal function was favorably maintained.
The discussion concerns the cause of renovascular hypertension which is characterized during renal or reteroperitoneal operation. In this case, spasm of the main renal artery was suggested to be the cause of hypertension, because torsion of the renal pedicle occurred during the operation and the hypertension was transient.
