THE RESPONSE OF NEOPLASTIC RENAL VESSELS TO EPINEPHRINE IN MAN.

Abstract

Neoplasms parasitize: the diversion of nutrients and oxygen is accomplished through the creation of a new vascular bed, which siphons blood from the organism into the tumor. The neovascular architecture differs from the old; it has been suggested that its response to conventional neurohumoral stimuli differs from that of normal vessels (3). The evidence, however, is fragmentary at best. Some years ago, as a first step toward testing this hypothesis, we undertook a study of the response of the normal renal vascular bed in dogs to one specific drug, namely, epinephrine (1). More recently, I have investigated the effect of epinephrine on the tumor vessels in malignant hypernephroma in man, an effect which is of interest and perhaps of some importance. Clinical Porblem The patient, a 69-year-old man, had his first bout of painless, gross hematuria two months prior to admission. This subsided spontaneously. Two days before admission, he suffered a recurrence, associated with minimal left flank pain. On admission, physical examination demonstrated no gross abnormalities. The blood pressure was 158/88. The patient was obese and weighed 213 pounds. Laboratory data included a blood urea nitrogen of 22.5 and the finding of grossly bloody urine. On intravenous urography, contrast concentration in the collecting system was poor on both sides. The right kidney was thought normal, the left possibly enlarged, but with inadequate definition of calyces and pelvis. Cystoscopy revealed a slightly edematous and erythematous left ureteral orifice, with a small fragment of foreign material protruding from it. A single spurt of blood was noted, entering the bladder from the left ureter. Retrograde pyelography demonstrated a normal right kidney. On the left side, there was some distortion of the middle and lower pole calyces and their infundibula. The pyelogram was considered abnormal, but not conclusive as to the diagnosis. As a consequence, the patient was referred to the author for renal arteriography. The clinical problem, then, was sharply defined: what was the cause of the hematuria? Was there, in brief, a surgical lesion such as carcinoma in the left kidney? Could a diagnosis specific enough to warrant surgery in this obese, 69-year-old man be established? Experimental Problem If a carcinoma was present, as seemed likely, a comparison of the response of tumor vessels and of normal vessels to a specific pharmacologic agent might be feasible. For such a comparison, it was necessary that distinctive tumor vessels subserving the tumor be defined, and that the blood supply of the tumor be clearly distinguishable from adjacent normal vessels. Obviously, a control renal arteriographic study was required. Thereafter, the drug might be injected directly into the renal artery, followed by additional renal arteriograms.