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Renovascular hypertension: Renin measurements to indicate hypersecretion and contralateral suppression, estimate renal plasma flow, and score for surgical curability

1973; Elsevier BV; Volume: 55; Issue: 3 Linguagem: Inglês

10.1016/0002-9343(73)90139-3

1555-7162

E D Vaughan, Fritz R. Bühler, John H. Laragh, Jean E. Sealey, L. Baer, Richard H. Bard,

Renal and Vascular Pathologies

Abstract Twenty-nine hypertensive patients with renal arterial stenosis were evaluated preoperatively with determinations of peripheral renin activity and differential renal vein renin levels. Three indicators were defined and evaluated to identify renovascular hypertension and to predict its curability: (1) an abnormally high peripheral plasma renin activity in relation to sodium excretion indicating increased renin secretion, (2) complete suppression of renin secretion (V−A ~ O) from the contralateral uninvolved kidney, and (3) an abnormally increased renal vein renin content relative to arterial renin from the suspect kidney [(V−A)/A > 0.48] which reflects and can be used to estimate the degree of renal ischemia, provided there is complete suppression of renin secretion from the contralateral uninvolved kidney. Each of the three indices, taken separately, are subject to sufficient technical variability to make them somewhat unreliable. Accordingly, a scoring system has been devised which weighs information contributed by each of the three indicators that appears to provide a high order of predictability of cure of renovascular hypertension. In 19 adult patients, in whom all three indices were measured, this scoring system predicted surgical cure in 13 of 13 (100 per cent), as well as lack of cure in 5 of 5 (100 per cent) and identified a technical error in 1. Altogether this analysis of the data supports the view that abnormal renin secretion is intimately involved in the pathogenesis of curable renovascular hypertension in man.