Persistent arterial hypotension after bilateral nephrectomy in a 4-month-old infant

A patient with congenital nephrotic syndrome underwent bilateral nephrectom y at the age of 4 months. She showed persistent hypotension from the fourth postoperative day until death at the age of nearly 5 months. No cause for the hypotension could be found. It is postulated that, especially in young infants, a deficiency of renin after bilateral nephrectomy may cause persis tent hypotension. An explanation for the putative increased risk of this co mplication in young infants may be their need for a highly active renin-ang iotensin system. Until more is known about the incidence of this complicati on and its predisposing factors, reluctancy towards the performance of bila teral nephrectomy in children under the age of 6 months is warranted.