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Unilateral Renal Artery Stenosis Seen Initially as Severe and Symptomatic HypokalemiaPathophysiologic Assessment and Effects of Surgical Revascularization
Steven T. Ruby, MD;
Andrew Burch, MD;
William B. White, MD
Arch Surg. 1993;128(3):346-348.
Abstract
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• Hypokalemia is an uncommon presentation of renovascular hypertension. Although renal artery stenosis has been associated with hypokalemia secondary to hyperreninemic hyperaldosteronism, few reports have actually evaluated the pathophysiologic changes in such a patient with renovascular hypertension. We studied a patient before and after surgical revascularization who presented with severe hypertension and marked, symptomatic hypokalemia. Before surgery, the patient had excessive urinary potassium secretion, markedly increased secretion of renin after captopril stimulation, and mild secondary hyperaldosteronism. Postoperatively, the patient's blood pressure decreased moderately and the serum and urinary potassium values normalized. After revascularization, plasma renin activity both before and after captopril stimulation and serum aldosterone levels decreased markedly. These findings demonstrate that renovascular hypertension may rarely present with symptomatic hypokalemia secondary to excessive aldosterone secretion. Improvement in the renal ischemic state is accompanied by rapid correction of the metabolic disturbances associated with hyperreninemic hyperaldosteronism.
(Arch Surg. 1993;128:346-348)
Author Affiliations
From the Section of Vascular Surgery, Department of Surgery (Drs Ruby and Burch), and Section of Hypertension and Vascular Diseases, Department of Medicine (Dr White), University of Connecticut School of Medicine, Farmington.
Footnotes
Accepted for publication March 21, 1992.
Reprint requests to Section of Hypertension and Vascular Diseases, Department of Medicine, University of Connecticut Health Center, Farmington, CT 06030 (Dr White).
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