PERCUTANEOUS TRANSCATHETER RENAL ABLATION WITH ABSOLUTE ETHANOL FOR UNCONTROLLED HYPERTENSION OR NEPHROTIC SYNDROME - RESULTS IN 11 PATIENTS WITH END-STAGE RENAL-DISEASE

PURPOSE: Retrospective review of authors' experience with percutaneous transcatheter renal ablation in patients with uncontrolled hypertensi on and/or nephrotic syndrome. MATERIALS AND METHODS: Between April 198 7 and September 1995, renal ablation was performed on 11 patients aged 10 months to 21 years. All patients had end-stage renal disease (ESRD ) with uncontrolled hypertension (10 patients) and/or nephrotic syndro me (four patients), Uncontrolled hypertension was defined as diastolic pressure greater than 90 mm Hg despite multidrug antihypertensive the rapy, Nephrotic syndrome was defined as proteinuria exceeding 960 mg/m (2) per day, serum albumin level less than 3 g/dL, and generalized ede ma, Embolization was performed with absolute ethanol from a common fem oral artery approach, In most cases, a balloon catheter was used to pr event alcohol reflux into the aorta or nontarget renal artery branches , such as the adrenal arteries. Angiographic stasis of contrast materi al in the renal arteries was the endpoint. RESULTS: All patients exper ienced a postembolization syndrome of 3-5 days duration, clinically ma nifested by variable degrees of nausea, vomiting, fever, and pain, Lon g-term improvement in hypertension was observed in nine patients, Impr ovement in hypertension was defined as diastolic blood pressure below 90 mm Hg while the patient received the same or fewer antihypertensive medications, The four patients with nephrotic syndrome were cured of their proteinuria and edema. CONCLUSIONS: Transarterial renal ablation with alcohol is efficacious for treatment of uncontrolled hypertensio n and nephrotic syndrome in patients with ESRD, The morbidity and mort ality in our series were less than those reported for surgical nephrec tomy.