LONG-TERM EFFECTS OF THE REDUCTION OF FUNCTIONING RENAL MASS

We studied 88 patients with-reduction of renal mass (unilateral nephrectomy or renal hypoplasia/agenesia). The aim was to determine the prevalence of renal disfunction and its mechanism, and to define the effect of several hypotensive drugs on the kidney functional abnormalities. They have reduced renal mass for 311.2 +/- 248 months. Chronic renal failure was diagnosed in 27 patients and 26 had sinificant proteinuria. Proteinuria was correlated with time of reduced renal mass and with chronic renal failure. Furthermore, patients with kidney hypoplasia or agenesia had significantly greater levels of proteinuria than nephrectomized patients. From 33 patients with normal renal function and normal blood pressure microalbuminuria was detected in 29, with a significant correlation with time of evolution. High blood pressure was detected in 55 patients (22 of them had proteinuria); 29 were treated with Angiotensin-converting enzyme inhibitors; 13 with Calcium entry-blockers and 13 with other drugs. We did not find significant differences in these groups with respect to blood pressure control and reduction of proteinuria. We conclude that microalbuminuria is highly prevalent in patients with chronic hyperfiltration and reduced renal mass. We found a great incidence of kidney disfunction (increase in plasma creatinine and proteinuria), which was related with duration of reduced renal mass and with the existence of this situation at a younger age. The high blood pressure is frequently found in patients with reduced renal mass. Hypotensive drugs used in our study showed similar blood pressure control and decrease of proteinuria in patients with reduced renal mass.