AN APPRAISAL OF CERTAIN TESTS FOR THE DETECTION OF HYPERTENSION OF UNILATERAL RENAL ORIGIN

Abstract

In the search for reversible hypertension of unilateral renal origin one or more special tests were done on 122 patients. Measurement of differential renal excretion of urine and its sodium concentration was attempted in all, and satisfactory data were obtained in approximately 1/2. There were 3 positive tests, suggesting reversible hypertension due to unilateral renal arterial disease. Two tests were false-positive and the 3d was in a patient who refused all other studies. There was 1 false-negative test in a woman with segmental infarction of her right kidney whose hypertension was cured by heminephrectomy. Negative tests were confirmed in 2 patients who were not improved by removal of kidneys with slightly narrowed renal arteries. Translumbar renal angiography was not an innocuous procedure. Some complications developed in 1/4 of 24 patients including 1 who died from a severed intercostal artery. There was 1 false-positive renal angiogram and a demonstrably narrowed renal artery was confirmed at operation in 1 woman who was not improved by nephrectomy. Tetraethylammonium chloride tests were not reliable in predicting reversible unilateral renal arterial hypertension. In 11 patients there was 1 false-positive and 1 false-negative test. I131-labeled diodrast renograms were obtained in too few patients to allow evaluation. There is as yet no completely reliable test to detect correctible renal hypertension.