Hypertension due to unilateral renal arterial obstruction: Preliminary observations on the contribution of differential renal clearance studies

Stenosing Lesions of the Renal Arteries

“…In only five instances was the hypertension presumably secondary to renal ischemia; the remaining 15 patients had unilateral pyelonephritis. In agreement with these observations, Howard and associates 8 noted an abrupt onset of hypertension and rapid progression in an early group of patients cured by nephrectomy. Subsequently other investigators suggested that the appropriate tests for renovascular hypertension generally should be limited to patients meeting the following clinical criteria:…”

Diagnosis and Treatment of Renal-artery Stenosis

“…; and, usually, diminished urinary concentrations of sodium anid chloride. As Birchall et al (1958) have pointed out, the final urinary concentration of sodium depends upon two variables, the tubular reabsorption of water and of sodium. It is therefore possible that the proportions of both the filtered water and the sodium reabsorbed on the side with the stenosis could exceed those on the normal side, and yet the final urinary concentration of sodium be higher on the former.…”

“…Similar calculation was not possible in Case 17, since leakage around the ureteric catheters occurred, and the inulin clearance consequently could not be determined. Birchall et al (1958) reported a proved case of renalartery stenosis in which ureteric catheterization studies showed persistently higher sodium concentration in the urine from the affected kidney. These workers similarly were able to show that a higher proportion of the filtered sodium and water was reabsorbed on the affected side.…”

The Characteristics of Renal Hypoperfusion in Dogs with Acute and Chronic Reductions in Glomerular Filtration Rate as Disclosed by the Pattern of Water and Solute Excretion after Hypotonic Saline Infusions *

“…Mueller, Surtshin, Carlin, and White (13) were able to demonstrate in dogs with split bladders and unilateral renal arterial constriction undergoing water diuresis that small reductions in GFR were associated with disproportionate reductions in urine sodium concentration. However, in patients with partial renal arterial constriction, the concentration of sodium on the ischemic side has not been uniformly depressed (5,14,15). The present experiments provide a framework by which these apparent discrepancies may be resolved.…”