RENAL VENOUS RENIN-ACTIVITY IN VARIOUS FORMS OF CURABLE RENAL-HYPERTENSION

Abstract

The diagnostic and predictive value of renal venous renin determinations was investigated in 73 patients who had various forms of hypertension associated with unilateral renal disease and who were operated upon. Patients with fibromuscular hyperplasia showed a markedly higher cure rate than cases with arteriosclerotic renal artery stenosis (64 vs. 25%) and were less frequently not improved (4 vs. 12%). Patients with unilateral (non-vascular) small kidney and patients with unilateral hydronephrosis showed comparable high cure rates (53 and 50%, respectively); in no patient with a unilateral renal cyst did postoperative blood pressure return to normal. No statistically significant correlation was found between postoperative pressure reduction and PRA[plasma renin activity]-ratios in the whole group of patients or in the various subgroups. A negative PRA ratio (.ltoreq. 1.4) was found in 36% of all cured patients. Cured patients with fibromuscular hyperplasia showed a high percentage (38%) of falsely negative tests. As expected, characteristic differences were observed in simple clinical data between cured and improved patients. Patients with normal postoperative blood pressure were significantly younger (34.7 .+-. 13.6 yr) than improved cases (47.3 .+-. 10.8 yr; P < 0.001) and cured patients showed lower preoperative blood pressure values (192 .+-. 29/119 .+-. 15) than improved ones (214 .+-. 31/126 .+-. 17 mm Hg). A limited prognostic value of renal venous renin determination is documented in patients with hypertension due to unilateral renal disease.