Solitary kidney and ageing as causes of low renin and aldosterone concentrations: relevance to "low-renin" essential hypertension.

Abstract

1. As experimental models of reduced nephron population in man, (a) twelve men aged 15-32 years who had one kidney removed 1-13 years previously and (b) fourteen normotensive men aged 70-90 years were studied. Results were compared with those in eighteen normotensive men aged 18-28 years and eleven men aged 19-33 years with essential hypertension. 2. While the subjects followed a routine of normal diet and daily activity, measurements were made, after overnight recumbency and in the fasting state, of plasma volume and renin activity on one occasion in hospital and of blood pressure on five to fourteen occasions in the home. Blood pressure was also measured after standing for 2 min and plasma renin activity after 1 h standing, sitting or walking. Twenty-four hour urinary aldosterone excretion was also measured. 3. The measurements were repeated in the normotensive subjects and subjects in (a) and (b) above after 10 days of sodium-restricted diet (40 mmol of sodium/day). 4. The mean plasma renin activity (recumbent) in essential hypertensive subjects was higher than in normotensive subjects. In subjects of (a) and (b) above, it was lower than normotensive subjects, and was not increased by dietary sodium restriction in subjects of (a). 5. The mean aldosterone excretion level was lower in old normotensive subjects than in the other groups, and increased in each group after dietary sodium restriction. 6. Mean plasma volume/surface area was not different between the four groups and in normotensive, essential hypertensive and nephrectomized subjects but not subjects aged 70-90 years was negatively correlated with standing diastolic blood pressure.