Sir.—I am writing concerning the case report and review by Dr. Siegler, which appeared in the December issue of the Journal (128:853, 1974). He described the unsuccessful treatment of malignant hyperreninemic hypertension in an 11-year-old girl who subsequently underwent bilateral nephrectomy and allograft transplantation. It is an excellent summary of the subject but leaves unsaid several important points concerning this fortunately rarely encountered problem in pediatric practice.
Bilateral nephrectomy for hypertension is a procedure of last resort when all other means for control of high-renin hypertension have failed. Nephrectomy is irrevocable and imposes the need for dialysis and transplantation with their many problems and less-than-ideal survival rates. We have at our disposal an alternative. Contrary to Dr. Siegler's statement, there have been positive, though not widely reported, results with minoxidil therapy in children.1-3 This potent, orally administered vasodilator is now available (though it probably was not when Dr. Siegler's