Sympathetic overactivity plays a crucial pathogenetic role in the genesis of hypertension in Autosomal Dominant Polycystic Kidney Disease (ADPKD). Although the use of multi-drug therapy in ADPKD, successful control of blood pressure (BP) occurs in less than 30% of patients. Renal denervation has been shown to be effective and safe in reducing BP in patients with treatment-resistant hypertension, even with chronic kidney disease (CKD). However, there are no cases in hypertensive patients with ADPKD or with single-kidney. We report the exceptional case of a single-kidney woman with stage 4 CKD secondary to ADPKD and uncontrolled treatment-resistant hypertension.
Our patient, a 50-year-old woman with stage 4 CKD secondary to ADPKD, showed a severe resistant hypertension (BP> 200/110 mmHg), hypokalemia and metabolic alkalosis. Therefore, a diagnosis of hyperaldosteronism was investigated, and a hypoplasic left renal artery was diagnosed. Because of the BP values constantly elevated, the anatomical anomaly of the left renal artery, the reduction of left kidney functional capacity < 10% of total function showed at the scintigraphy, and the absence of evidence for significantly accelerated progression of renal failure in uninephrectomized ADPKD patients, removal of left kidney was performed, without complications or worsening of renal function. However, three months later, the patient showed a progressive worsening of hypertension. Because of the ineffectiveness of all pharmacological and surgical therapeutic strategies, renal denervation by radiofrequency ablation of the right renal artery was finally performed.
The patient decreased the requirement of antihypertensive medication and the BP showed a remarkable reduction, that resulted stable 12 months after the procedure. We did not observe any uncontrollable adverse event during the procedure or during the short-term follow-up of 12 months.
This is the first case showing the safety and feasibility of a catheter-based renal denervation approach, in a single-kidney CKD patient with resistant hypertension and ADPKD.
