Plasma Renin Activity and Blood Pressure in Terminal Renal Failure

The predictive value of renin determinations in selection of patients with terminal renal failure and hypertension for bilateral nephrectomy was evaluated in 51 patients maintained on chronic hemodialysis. Nine patients were normotensive before dialysis (Group 1); of the 42 hypertensive subjects, blood pressure was controlled by sodium restriction and Ultrafiltration in 24 (Group 2), but was resistant to these modalities and antihypertensive drugs in 18 (Group 3). Moderately to markedly increased plasma renin activity (PRA) levels clearly distinguished the 17 patients of Group 3 whose hypertension was improved by nephrectomy from patients with sodium-volume-dependent hypertension treatable by dietary restrictions and hemodialysis (Group 2). One patient of Group 3 had a normal PRA and did not benefit from nephrectomy. alpha-methyldopa consistently decreased PRA and should be withdrawn before diagnostic studies. In 16 of our 17 cases of hypertensive hyper-reninemic terminal renal failure the underlying renal disease was nephrosclerosis or glomerulonephritis.