Characteristics of renovascular hypertension

A follow-up study of hypertensive patients after operative treatment of unilateral renovascular or renal disease

A study of 44 hypertensive patients with unilateral renovascular or renal parenchymal disease is presented. All patients underwent corrective surgery. Out of the 44 operated patients, five did not participate in the follow-up examination. The remaining 39 patients constitute the study population. The effects of surgery on the hypertensive state could be evaluated in 35 patients, whereas four died less than two months after the operation. Follow-up studies were carried out at 8-60 months after the operation. The average period of observation was 32 months; 24 patients were observed for more than two years. As a group, the patients had severe hypertension with extensive target organ damage and widespread atherosclerosis. A fairly rigorous selection process was applied, and an unsatisfactory response to medical management was considered a point of major importance. In the majority of cases, renovascular lesions were atherosclerotic, with only two cases of fibromuscular dysplasia. Unilateral nephrectomy was performed in 32 patients, whereas seven underwent reconstructive vascular surgery. Out of 35 patients, 22 (63%) were cured, 8 (23%) improved and 5 (14%) unaltered. A gratifying regression of hypertensive lesions in target organs was observed in patients who were cured or improved by surgery. The frequency and severity of postoperative complications were related to the presence of extrarenal vascular disease.

Assessment of total and divided renal plasma flow by 123I-hippuran renography

We studied 23 patients with suspected renal hypertension, including 12 with renal artery stenosis, or occlusion. Total effective renal plasma flow (ERPF) was measured in all patients by conventional p-aminohippurate (PAH) clearance and by 123I-hippuran clearance performed on the same day. A close correlation between the two techniques was obtained (r = 0.87, P less than 0.001) with the latter technique underestimating the former by a mean ratio of 0.89:1.00. We describe a technique for deriving ERPF for individual kidneys by 123I-hippuran renography, and the data obtained by this method correlate well with data obtained from bilateral ureteric catheterization studies (r = 0.076, P less than 0.001 for both affected and unaffected sides) in 17 patients. The renographic technique is particularly accurate in quantitating ERPF in the 12 patients with renal artery stenosis, and is recommended as the investigation of choice in the assessment of ERPF in patients with this condition.

Renovascular hypertension treated by autotransplantation

Renal autotransplantation was performed in 16 patients with severe renovascular hypertension. The hypertension was cured in 13 patients, 2 patients were improved and one patient had no benefit. The postoperative function and morphology of the transplanted kidneys remained unchanged. In our view, renal autotransplantation is a valuable method in the surgical treatment of renovascular hypertension.