Renal Sympathectomy: Its Scope and Limitations

Abstract

Indications for renal sympathectomy, which are deemed to be warrantable by our present state of knowledge. A disease syndrome is described in detail under the title of “renal sympatheticotonus.” This is an obstructive nephropathy in which the neuromuscular dysfunction causing the faulty drainage is typically unilateral and due presumably to overactivity of the sympathetic nerve supply to the kidney. The outstanding features are unilateral renal stasis, renal pain and costo-vertebral tenderness, their recurrence after temporary relief by eserine, and the absence of any demonstrable cause of organic obstruction. Three stages, which are readily demonstrable by pyelographic methods, are described, namely, ( a) the stage of irritability or systole, ( b) the stage of diastole or exhaustion, and ( c) the stage of paralysis or hydronephrosis. Immediate and permanent relief of symptoms is afforded by renal sympathectomy in stages ( a) and ( b). (7) In stage ( c) the aid of plastic surgery may be necessary to overcome secondary organic obstruction. (8) The best interests of surgery in general and of renal sympathectomy in particular will be conserved by rigidly confining the operation to the type of case described.