Predictability of surgical response in renovascular hypertension
J. A. Buda, L. Baer, J. Z. Parra-Carrillo, M. M. Kashef, F. F. McAllister, A. B. Voorhees and C. L. Pirani
One hundred sixteen patients underwent operation for renovascular
hypertension from 1962 through 1975; 64% had aortorenal reconstruction and
36% had nephrectomy. Sixty-six percent were cured and 19% were improved.
Rapid sequence intravenous pyelography, radioisotope renography, and renal
arteriography were equal in ability to detect renovascular hypertension.
Bilateral renal biopsy specimens had excellent prognostic value when
performed in a graded semiquantitative manner. Plasma renin activity was
the most consistently useful criterion for prediction of surgical cure if
the following requirements were used: (1) elevated peripheral plasma renin
activity, (2) elevated renin from the affected kidney, and (3) suppressed
renin secretion from the contralateral kidney. An angiotensin II
antagonist, saralasin acetate, used in six patients before operation in an
attempt to identify those whose hypertension depended on angiotensin II
activity, produced a depressor response correlating well with the surgical
result.
