156. The role of renal biopsy in the diagnosis of renovascular hypertension

College ‘1 he

cflort

arc‘as

trst

through

not only

with

which

feasible

muscular

because

regarding

the

of the

extends

is

which

and

the

therapeutics

authors

discuss

tion.

of

in

this

156.

The Role of Renal

Biopsy

in the Diagnosis

VICTOR VERTES,

Hypertension,

and .JAMES A. GRAUEL. M.D., Cleveland, In recent

years renewed

the role of the kidney

interest

ability

and separate

renal function

number

of cases

hypertension. diseased many

renal

patients

are

or renal

subjected

vessel repair

ant cure of their hypertension. abnormal renal

renal

separate

arteriograms,

these patients

or both.

have

disease as the primary One

hundred

Separate

a modification obtained and

presence

renal function

of the technic

proposed

on all of the patients.

bilateral

percutaneous

that

small

vessel

patients

Separate

renal

function

in renovascular

studies

arteriography

biopsies

were

consistent

per-

with the

and abnormal

repair

renal

of the

transient

decrease

essential

hypertension ble renal lateral

vessels

in blood

in selection

vessel

in patients

disease.

is contraindicated would

result

pressure.

suspected cannot

intrarenal

a

biopsy

is

Cure of the

of having

reversi-

be anticipated small

if bi-

vessel disease

is

present. 157.

Ischemia,

of

the

Myocardium

BERNARD

M.

WAGNER,

to

Acute

M.D.,

RALPH

STREREL, PH.D. and LILLIAN BEDELL, B.A., New York. Following (LAD)

cardium various

acute ligation coronary

was

studied

microscopic

were obtained complete

JANUARY 1964

of the left anterior

artery

in the

at varying technics.

dog,

time

descendthe

intervals

Myocardial

myoby

samples

1, 2, 3, 4, 6, 8, 12, 24, 36 and 48 hours occlusion

of the LAD.

changes

remain

for con-

is rapidly

enzymes

associated

preserved

for

of the study will

Tissues

Cardiomegaly

were

and Weak

COL.

Fistula,

systemic

Systemic

WELDON J.

WAI.IXR

MUI.LINS (MC) and

arteriovenous pulses

heart

infant

pressure

or flush method.

large arteriovenous

fistula between

and innominate lesion.

patients

with

have

heart

cyanotic.

to explain

Consideration

resistance

Such

lowering

striking monary ovale

vascular is patent.

arteriovenous

The

larger

resistance In such

right

infant,

in pul-

is high and the foramen a large

right atria1 pressure

pres-

the more

and increase

increase

elevate

massive

the fistula

will markedly

return

As

pressure

a setting,

to the

reduce

output.

arterial

In the newborn

venous so that

strikingly

the result

in pressure

work.

fistula

caused

and right atria1 mean

is this elevation

ventricular

not at-

resistance

systemic

arterial

sures are increased.

changes

cardiac

in pulmonic

of mean

while pulmonary

infancy,

have

fistulas in animals

fistulas

and increase

there is no reduction

most

listulas,

of the cyanosis.

arteriovenous

this cyanosis.

cardio-

that

in early

authors

of the hemodynamic

systemic

right

failure

the mechanism

by large experimental

a

the left subclavian

arteriovenous

Previous

explains

either

At necropsy.

indicates

systemic

congestive

been

tempted

literature

large

This

was unobtainable

vein was the primar),

The

usually charar-

whose pulses were

by the auscultatory

vascular

are

disease

and cardiomegallr.

deals with a cyanotic

artery

CAPT.

D.C.

fistulas

a form of acyanotic

by bounding

Pulses-

Congenital

so weak that blood

is a Reactivity

in pro-

suggests

GEORGE C. KNOVI~~ (MC), Washington,

producing

and

in only

Renal

of cases for surgery.

hypertension

obliterative

small

increase

While glycogen

(MC), CAPT. CHARLES E.

report

intrarenal cases

\vere

of the involved

with interfibrillar

myofibers,

of Massive

Arteriovenous

terized

were

vanced

in these

stroma

phosphorylation

Cyanosis,

studies utilizing

were found in many cases with ad-

bilateral

*158.

Large

renal arteriograms Nephrectomy

no myofila-

lack of histoenzymatic reserve.

after

cardiac

Of interest

long periods of time. The implications

by Stamey

hypertension

showed

hours.

associated

from ischemic

considered

formed on select cases. findings

eight

How-

hours

antidog

was a marked

metabolic

depleted

of renovascular

Renal

renal

Rabbit

up to four hours after ligation

A Manifestation

abnormal

hypertensive

were studied for the possible hypertension.

cases may have

cause of their hypertension.

seventy-five

a period

four

a result-

studies,

intrarenal

until

fluorescein

There

enzymes

dehydrogenases.

in the perivascular

myocardium.

solu-

be discussed.

to unilateral

It is our contention

bilateral

most sensitive

noted

until

Carnoy

and immunochemical

The

flow.

with

changes

with oxidative

these ad-

without

These

function

of

to correct

Despite

blood

labeled

mentous

siderable

renovascular

it possible

of

substi(ution.

in O.l(:& cet)rlp)ri-

and modified

are the myocardial

edema. The striking

the

skill in the repair

arteries.

formalin

were

l’rccze

fixed

histochemical

no changes

myosin

b!

were

teins and polysaccharides

aortography

of having

vessels has made

many

in

Improvement

of renal

surgical

of the renal

nephrectomy

has developed

prepared

were performed.

to ischemia

alterations

studies has increased

suspected

Increased

defects

vances

by means

of M.D.

Ohio.

in hypertension.

of diagnostic

after

chloride,

cessation

Renovascular

and

specimens

Extensive

studies ever,

paper.

ing

quick-Frozen Duplicate dinium

simplicity

but also allows of inferences

physiopathology

pain,

pain

of its technical

and its demonstrativeness, coronaq

exercise

the subjective

Nays

right

atrium,

will

systemic systemic strikingly

above left atria1 pressure,

to left shunting

through

the