Clinical Evaluation in 80 Patients with Renovascular Hypertension

Eighty cases of renovascular hypertension including 47 with unilateral main renal arterial stenosis (UMRAS), 16 bilateral main renal arterial stenoses (BMRAS), 15 renal arterial branch stenosis (RABS) and 2 unilateral main renal arterial stenoses with contralateral renal arterial branch stenoses were studied. Abnormal findings were observed in 84% of UMRAS, 73% of BMRAS and 74% of RABS by rapid sequence pyelographic study, and in 84% of UMRAS, 63% of BMRAS and 54% of RABS by radioisotope renographic study. The ischemic pattern was obtained in 69% of UMRAS, 50% of BMRAS and 40% of RABS in split renal function test. High resting peripheral vein blood plasma renin activity values were obtained in 67% of UMRAS, but in only 33% of BMRAS and RABS. Hyperresponsiveness of renin secretion was found in 80% of BMRAS and 56% of RABS. A significant elevation of PRA in the stenotic kidney was found in 78% of UMRAS and 50% of unilateral RABS. Angiographic study revealed unilateral vascular lesion in 60 cases and bilateral in 19 cases. Development of collateral circulation was found in 73% of cases. Forty-nine cases underwent a surgical treatment and 40 cases of them were cured or improved. The most reliable diagnostic and prognostic criteria for surgical curability were to demonstrate collateral circulation and elevated peripheral vein PRA levels with increased renin secretion from the affected kidney. The postoperative course of blood pressure was examined with regard to the PRA in 18 nephrectomized and in 12 revascularized patients. The normalization of blood pressure was quicker in the latter than in the former, while the normalization of PRA was quicker in the former than in the latter.