In Reply.—The points raised in the letter of Dr. Aronson are certainly important and deserve emphasis.
Bilateral nephrectomy is undeniably a drastic measure and should only be considered for those whose hyperreninemic hypertension is refractory to medical management. I certainly wish that we had had minoxidil to use for our patient. Since then, pediatric experience with minoxidil has increased, though the total number of published cases is still relatively small.
I, too, have recently used this experimental agent to successfully treat two pediatric patients with refractory hypertension. One patient had chronic interstitial nephritis from vesicoureteral reflux and the other had experienced a recurrence of the hemolytic-uremic syndrome.
Even so, I doubt that minoxidil will turn out to be a hypertensive panacea. I suspect, therefore, that bilateral nephrectomy will still have to be considered for the occasional patient. But hopefully, the need for such an extreme measure will be