Renovascular hypertension with unilateral atherosclerotic renal artery occlusion: diagnostic use of renal vein renins.

Abstract

Selective renal vein renin studies were performed in seven male patients with severe hypertension and atherosclerotic occlusion of a main renal artery. In five patients, peripheral plasma renin activity was increased, and there was evidence for hypersecretion of renin from the affected kidney and suppression of renin release from the opposite kidney. In one patient, who had occlusion of one renal artery and a high-degree stenosis of the contralateral renal artery, the two kidneys appeared to contribute equally to the high circulating plasma renin activity. Removal of the atrophic, ischemic kidney from these patients, plus bypass of the contralateral renal artery in one patient, resulted in cure or improvement of their hypertension. In one patient, despite hypersecretion of renin from the atrophic kidney, surgery was not recommended because his systemic blood plasma renin activity was not elevated. Histologic examination of the excised kidneys revealed moderate glomerular scarring and tubular atrophy. The findings indicate that the same criteria, derived from renal vein renin studies, that have been used to predict the outcome of surgical repair of renal artery stenosis in hypertensive patients can be applied to the evaluation of patients with hypertension and complete occlusion of a main renal artery.