THE DIAGNOSTIC APPROACH TO HYPERTENSION DUE TO UNILATERAL KIDNEY DISEASE

Abstract

Nephrectomy was performed on 5 patients with vascular lesions and resulted in "cure" of the hypertension in 4. Five patients with parenchymal lesions likewise underwent nephrectomy but hypertension continued after operation. Four of the latter patients had unilateral shrunken nonfunctioning pyelonephritic kidneys. Failure of the blood pressure to fall in response to a ganglionic blocking agent (TEAC) was noted pre-operatively in the patients ultimately "cured" by nephrectomy while the surgical "failures" showed depressor TEAC responses similar to those of the general hypertensive population. Testing with ganglionic blocking agents may supply useful information from at least 3 standpoints: (1) in identifying patients in the general hypertensive population who should be suspected of having a humoral source for their hypertension; (2) to characterize the hypertension as being of renal origin when a unilateral renal lesion has been demonstrated; and (3) consistent pressor response or lack of blood pressure fall to ganglionic block in unilateral renal hypertension may indicate potential reversibility of the hypertensive process.