HYPERTENSION AFTER SURGICAL-MANAGEMENT OF RENAL DUPLICATION ASSOCIATED WITH AN UPPER POLE URETEROCELE

Purpose: Duplicated upper pole systems associated with a ureterocele f requently have areas of segmental renal dysplasia. Since dysplasia has been related to the development of renin mediated hypertension, we hy pothesized that preservation of functional upper pole moieties may res ult in an increased incidence of high blood pressure. Materials and Me thods: We evaluated 115 patients with a history of renal duplication a nd an ipsilateral upper pole ureterocele. Patients were separated into group 1-nonfunctional upper pole managed by partial nephrectomy, grou p 2-functional upper pole moiety managed by partial nephrectomy and gr oup 3-functional upper pole moiety managed by a nephron sparing proced ure. All charts were reviewed for hypertension, febrile urinary tract infection, vesicoureteral reflux and renal scarring. Results: At a med ian followup age of 15 years (range 1 to 33) hypertension developed in 13 of the 115 patients (11%), including 8 of the 87 (9%) with nonfunc tional upper pole systems managed by partial nephrectomy, 1 of the 12 (8%) with a functional upper pole moiety managed by partial nephrectom y and 4 of the 16 (25%) with a functional upper pole system managed by an upper pole salvage procedure. Statistical evaluations failed to re veal any relationship between hypertension and preservation of the upp er pole system or between hypertension and vesicoureteral reflux. Rath er, elevation in blood pressure was found to be related to development of a renal scar after a febrile urinary tract infection. Conclusions: Hypertension in patients with a history of renal duplication associat ed with a ureterocele is directly related to renal scarring.