Renovascular hypertension following renal transplantation

Hypertension is common in patients following renal transplantation. Chronic rejection, native end-stage kidneys, and transplant renal artery stenosis may all contribute to hypertension through the renin-angiotensin system. We believe renin measurements are of interest and that the renin-angiotensin system mediates hypertension associated with native end-stage kidneys and transplant renal artery stenosis. However, our ability to interpret renin levels in transplant recipients is limited. Native bilateral nephrectomy should be considered in the rare transplant recipient with medically uncontrollable hypertension and no transplant renal artery stenosis. Major transplant renal artery stenosis should be repaired. At this time, percutaneous transluminal angioplasty of the renal artery appears to be a reasonably safe and efficacious first-line therapy. Surgical repair may be reserved for failures by the percutaneous method. Longer follow-up and larger numbers are required to determine if this optimism in percutaneous angioplasty of transplant renal artery stenosis is justified.