Renal sympathetic-nerve ablation for uncontrolled hypertension in a patient with single-kidney autosomal dominant polycystic kidney disease

Hypertension is common in patients with autosomal dominant polycystic kidney disease (ADPKD). The prevalence is 50% to 62% when renal function is still normal and increases to almost 100% in patients with chronic renal failure.1 Moreover, although the use of multidrug therapy in ADPKD is successful, achievement of blood pressure (BP) levels <130/80 mm Hg occurs in <30% of patients. The pathogenesis of hypertension in ADPKD is complex and depends on many interrelated factors. As renal cysts enlarge, they compress the renal vasculature causing intra-renal ischemia, attenuation of the renal vasculature, sympathetic stimulation, and intra-renal activation of the renin-angiotensin-aldosterone system. Klein and colleagues2 showed that hypertensive patients with ADPKD have increased sympathetic activity regardless of renal function. The finding of significantly higher levels of adrenaline and noradrenaline in hypertensive patients with ADPKD, regardless of their renal function, when compared with hypertensive patients without ADPKD, is consistent with these observations