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Renal sympathetic denervation for resistant hypertension in a patient with a single kidney

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To the Editor: We report a case of successful renal sympathetic denervation (RSD) treatment for resistant hypertension in a patient with a single kidney.13 RSD is performed via femoral arterial access, using a radiofrequency ablation catheter to deliver energy to the renal artery wall. When delivering RSD to a single kidney, potential renal artery vascular complications can have a significant negative impact on a patient’s renal function, compared with patients with two functioning kidneys.

Our patient was a 71-year-old man with resistant hypertension for many years. He had a congenitally absent left kidney. He was on five antihypertensive agents: candesartan/hydrochlorothiazide 32/12.5 mg daily, lercanidipine 20 mg daily, atenolol 50 mg daily, moxonidine 0.4 mg daily and prazosin 0.5 mg twice daily. Despite this, his blood pressure was poorly controlled, with systolic blood pressure readings frequently above 200 mmHg. Renal ultrasound demonstrated a normal right kidney with normal renal artery, and the left kidney could not be identified. A computed tomography renal angiogram confirmed a single right renal artery with no plaque or stenosis. Other secondary causes of hypertension had been excluded. Given refractory hypertension on…