Jane T. Kurtzman, MD, discusses interpreting hypertension risk in kidney trauma

In a recent interview, Jane T. Kurtzman, MD, discussed findings from an analysis that examined the relationship between renal trauma interventions and subsequent risk of hypertension.¹ The study reported that nephrectomy and angioembolization were associated with the highest risk. Kurtzman emphasized, however, that these results must be interpreted with caution due to limitations in sample size, particularly for patients who underwent angioembolization. Coding challenges made it difficult to identify large numbers of patients with kidney-specific procedures, limiting the statistical strength of the conclusions.

Despite these limitations, Kurtzman noted that the findings are biologically plausible. Both nephrectomy and angioembolization can affect the renin–angiotensin system, potentially leading to its upregulation and the development of chronic hypertension. She also highlighted important clinical factors that may contribute to the observed association. Patients who present hemodynamically unstable following renal trauma are more likely to require nephrectomy or angioembolization. This instability could result in transient injury to the contralateral kidney due to hypotension, which may later influence blood pressure outcomes. In the case of angioembolization, exposure to contrast agents during the procedure may further compound these risks.

Kurtzman stressed that it is difficult to disentangle whether the increased hypertension risk is primarily due to the intervention itself or to the patients’ initial clinical state. She described this as a “chicken-or-egg” problem, where both treatment choice and patient presentation likely play roles. A key limitation of the study was its reliance on MarketScan claims data, which lacks granular clinical details such as lab values and hemodynamic parameters at presentation. Without these data, determining causality remains challenging.

Ultimately, although the results suggest a meaningful relationship between certain renal trauma interventions and hypertension, Kurtzman underscored the need for further research with richer clinical datasets.

REFERENCE

1. Kurtzman JT, Swallow M, Horns JJ, Woodle T, McCormick B, Myers JB. Risk of hypertension after renal trauma: an analysis of a large insurance claims database. Urology. 2025 Jul 23:S0090-4295(25)00712-5. doi:10.1016/j.urology.2025.07.045