Characteristics of Renovascular Hypertension: Data on Renal Blood Flow and Analysis of Factors Predicting the Effect of Surgery

Abstract

From 1961–67 twenty-seven patients with renovascular disease and diastolic hypertension were treated with reconstructive vascular surgery, nephrectomy or heminephrectomy following selection according to general practice. Follow-up examinations were performed in 23 cases from 18 months to 5 years after operation. Twelve patients became normotensive, 4 were improved, and in 7 the operative treatment was without effect. The results of preoperative investigations of 131I-Hippuran renogram, morphology of juxtaglomerular apparatus, intravenous pyelogram, kidney size, heart size, duration of hypertension, renal blood flow, split function test, degree of stenosis, glomerular filtration rate, and pressure gradient over stenosis were compared with the condition of the patients at the follow-up examination. Although the heterogeneity of the material does not allow a precise conclusion, we suggest the following approach to selection of cases for surgery: when the significance of the hypertension, total renal function, and fitness for surgery have been assessed, renography and intravenous pyelography should be performed in suitable cases. If the results of the latter tests suggest unilateral renal artery stenosis, and if the opposite kidney is normal, aortography should be made. If the aortography reveals a stenosed artery in a small kidney, the morphology of the juxtaglomerular apparatus of the involved kidney should be examined. If the clinical features and the results of the tests are in agreement, we find renovascular surgery indicated.