Diagnosis and Treatment of Renal-artery Stenosis

Brown, Jerry M.; Owen, Kenneth; Peart, W. S.; Robertson, J. I. S.; Sutton, David

doi:10.1136/bmj.2.5195.327

Cited by 138 publications

(36 citation statements)

References 22 publications

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“…26 The blood pressure fell in 80 per cent of those who survived after corrective surgery. DeCamp and Birchall, 27 Feste et al 28 and Brown et al 29 have published similar experiences.…”

supporting

confidence: 56%

Hypertension Secondary to Renal Artery Occlusive Disease

et al. 1961

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Historically, the awareness of renal artery narrowing as a curable cause of hypertension has evolved gradually, highlighted especially by Goldblatt and Poutasse. The increasing use of renal arteriography over the past 8 years in this hospital has yielded a total of 70 patients with renal artery abnormalities out of 110 hypertensive patients examined. In order to select the hypertensive patients most likely to have demonstrable arterial lesions, certain indications for arteriography were used. Most useful among these were the presence of an epigastric bruit, malignant hypertension, atheroselerosis of the abdominal aorta, and recent onset of hypertension. However, no one indication was always present in patients with lesions or always absent in those without abnormalities. Of the 70 patients with renal artery abnormalities, 54 were considered to represent sufficient renal artery stenosis to be potential candidates for surgical correction, while 16 had minor renal artery abnormalities. Atherosclerotic lesions occurred in 63 per cent of the patients with significant lesions, fibromuscular hyperplasia in 28 per cent, unilateral renal artery hypoplasia or atrophy in 7 per cent, and one case had embolic renal artery occlusion. Fifty-four per cent of all patients with significant lesions had bilateral disease. The patients with atherosclerotic lesions and those with fibromuscular hyperplasia differed markedly in sex distribution, age, and severity of hypertension. It is suggested that the retrograde transfemoral catheterization technic may be associated with fewer complications in patients without extensive occlusive atherosclerotic disease of the aorta, and iliac and femoral arteries. At operation the radiologic findings were confirmed in all but one patient. Corrective surgical procedures were performed in 38 patients, including nephrectomy, endarterectomy, segmental resection with reanastomosis, and splenorenal arterial shunt. Of the 31 patients who survived, 25 (81 per cent) had a postoperative fall in blood pressure, 14 to normal, in addition to improvement in clinical status. The follow-up period, however, is not yet sufficiently long to permit definite conclusions. Seven patients died; most of these had bilateral renal artery disease and extensive atherosclerosis of the cerebral and coronary arteries. Divided renal function studies were of limited diagnostic value because of the high incidence of bilateral lesions. In all patients with significant differences in renal sodium and water excretion, a postoperative fall in blood pressure occurred, but the same number of patients with equal bilateral excretion also had a fall in blood pressure. The importance of suspecting renal artery lesions in hypertensive patients regardless of age, severity of hypertension, or renal function is stressed. The question is discussed whether all patients with sustained hypertension should undergo arteriography. Although further studies to determine the true prevalence of occlusive renal artery lesions in the hypertensive population are in order, the fact that 50 per cent of our 110 patients had occlusive lesions and 60 per cent of the operated cases had a fall in blood pressure attests not only to the prevalence of the lesion but also to its potential curability.

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“…26 The blood pressure fell in 80 per cent of those who survived after corrective surgery. DeCamp and Birchall, 27 Feste et al 28 and Brown et al 29 have published similar experiences.…”

supporting

confidence: 56%

Hypertension Secondary to Renal Artery Occlusive Disease

et al. 1961

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“…Excretion urography showed the right kidney to be 12.5 cm long and the left 15.0 cm long; the appearances were typical of right renal artery stenosis, 10 with initial delay followed by marked increase in contrast density on the right. Selective right renal arteriogram showed a tight stenosis in the middle of the main renal artery, with collateral circulation via the lumbar arteries.…”

mentioning

confidence: 99%

“…Selective right renal arteriogram showed a tight stenosis in the middle of the main renal artery, with collateral circulation via the lumbar arteries. Ureteric catheter studies (table 1) showed classical features 10 of severe unilateral renal artery stenosis, with marked reduction of urine flow, urinary sodium, creatinine and para-amino hippurate (PAH) clearances, and increased urinary creatinine and PAH concentrations, on the right.…”

mentioning

confidence: 99%

Renal artery stenosis with normal angiotensin II values. Relationship between angiotensin II and body sodium and potassium on correction of hypertension by captopril and subsequent surgery.

Atkinson¹,

Brown²,

Davies³

et al. 1981

Hypertension

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SUMMARYThe case is reported of a young woman with severe hypertension, unilateral renal artery stenosis, variously normal or marginally high plasma concentrations of active renin, angiotensin II, aldosterone, sodium, and potassium; and normal total exchangeable and total body sodium and potassium. Arteriograms and ureter catheterization showed the stenosis to be severe, but the unstimulated renal vein renin and angiotensin II differential to be modest. Captopril caused an initial fall in angiotensin II and arterial pressure. During prolonged captopril treatment, plasma angiotensin II and aldosterone remained depressed; exchangeable and total body sodium and potassium were unaltered. Blood pressure fell further to normal levels during prolonged captopril treatment, while subsequent surgical correction of the renal artery stenosis was curative; absolute values of blood pressure and plasma angiotensin II were similar in both situations.

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“…Das Volumen der Niere ist auf Grund der starken Vaskularisation des Parenchyms sehr yon der DurehblutnngsgrSBe abhs So fanden schon GOLDBnACT U. Mitarb. 3~ bei ihren klassischen Untersuchungen ehle Vermindernng 1,6,12,14,24,62,28,35,88,50,59,60,80,89. …”

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