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Renovascular Hypertension in the Patient With Severe Atherosclerosis
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factors as well. He also showed that blood pressure measurements in children do not have sufficient predictive value to justify prophylactic treatment in the hopes of avoiding adult hypertension. He supported efforts to obtain more accurate data on the subject but condemned any sweeping changes in the dietary habits of children in general. T.D.A. 1 figure, 11 references
Editorial comment. Blood pressure determinations in children are especially important since such a high proportion of those with hypertension have a renal and, therefore, potentially curable cause. There is a growing consensus that if blood pressure can be maintained in the normal range by whatever means all the sequelae of hypertension will be avoided. L.R.K. Renovascular Hypertension in the Patient With Severe Atherosclerosis
ies, with occlusion near the origin of the artery supplying the lower pole. Also, a 2 cm. right adrenal mass was detected during the capillary phase. The patient was hyperreninemic and had elevated plasma aldosterone levels in the sodium replete state. The ratio of plasma renin activity in blood from the left compared to that from the right renal vein was 1.8 to 1. At an operation a right adrenal pheochromocytoma and a ligated left renal artery were found. The adrenal tumor was removed and left nephrectomy was done. There was microscopic evidence of ischemic damage to the kidney. M.G.F. 5 figures, 34 references Parallel Adrenal and Renal Abnormalities in Young Patients With Essential Hypertension
R. E. FRY AND W. J. FRY, Department of Surgery, The University of Texas Health Science Center, Dallas, Texas
G. H. WILLIAMS, M. L. TUCK, J. M. SULLIVAN, R. G. DLUHY AND N. K. HOLLENBERG, Departments of Medicine and Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
Arch. Surg., 117: 938-941 (July) 1982
Amer. J. Med., 72: 907-915 (June) 1982
Patients with renovascular hypertension and widespread atherosclerosis represent a special problem in management. Surgical intervention is associated with a much higher morbidity and less satisfactory outcome than generally is seen in patients with disease limited to the renal artery. Despite this past experience, however, 22 such patients were subjected to a surgical attack upon the renal artery under controlled conditions, which included preoperative intravenous vasodilators and fluid replacement while being monitored by a Swari-Ganz catheter. There were no operative deaths. Ao;rtorenal bypass was performed on 17 patients, nephrectomy was done on 4 with thrombosed renal vessels and a variety of other procedures was done on occasion. Of all patients 95 per cent were either cured or improved, average blood pressure mea3urements decreasing from 211/123 to 136/81. All 4 patients with impaired renal function improved postoperatively and the 1 patient on dialysis was able to discontinue this after the operation. The authors conclude that widespread atherosclerosis should not categorically contraindicate surgical intervention in renovascular hypertension. T.D.A. 4 figures, 12 references
It has been observed that some patients with essential hypertension have decreased adrenal response to angiotensin II and in unrelated studies renal perfusion is unusually high in some patients. The renin-angiotensin system is the major determinant of aldosterone release and renal perfusion in normal men under the conditions of those studies. The present study in 18 young patients with recent onset of essential hypertension represents a coordinated approach with simultaneous assessment of cardiovascular, renal and endocrine factors during periods of high sodium intake, low sodium intake and shortterm volume depletion (induced by restricted sodium and furosemide) to determine whether these abnormalities are associated. During the 2 diets all of the variables measured were in the normal range except for blood pressure and peripheral resistance. However, the aldosterone secretory response to diureticinduced volume depletion on a low sodium diet was almost absent in 9 nonresponders compared to normal aldosterone increments in the other 9 patients. Also renal blood flow was significantly higher in the former 9 patients during a high sodium intake and a restricted sodium intake. Normally, control of angiotensin release by the adrenal and renal perfusion is dominated by angiotensin. Parallel blunting of the aldosterone and the renal vascular response despite appropriate and normal plasma renin activity confirms the impression that the abnormality resides in the interaction between angiotensin II and its receptors. It is suggested that there may be a parallel abnormality of the renal vasculature in these same patients. M.G.F. 5 figures, 3 tables, 26 references
Persistent Hypertension After Resection of a Pheochromocytoma
K. M. LEIDMERER AND J.M. KISSANE, Departments of Internal Medicine, Radiology, and Pathology, Washington University School of Medicine, St. Louis, Missouri Amer. J. Med., 73: 97-104 (July) 1982 A clinicopathologic conference is presented. A 23-year-old woman who presented initially with palpitations and hypertension had undergone removal of a left adrenal pheochromocytoma at another hospital 5 months earlier. Because of persistent hypertension and hypokalemia she was referred for further evaluation. Urine and plasma catecholamine levels were elevated. A computerized tomography scan revealed a 2 cm. mass within the right adrenal gland and the left kidney appeared smaller than the right kidney. An excretory urogram showed atrophy of the lower pole of the left kidney. The right kidney contributed two-thirds of the total renal function by radionuclide renal function study. Arteriography demonstrated 2 left renal arter-
TRANSPLANTATION Results of Renal Transplantation in a Small Centre D. LUDWIN, A. MORALES, T. A. SALERNO, M. COHANIM, M.A. SINGER AND P. A. F. MORRIN, Division of Nephrology, the Division of Vascular Surgery and the Department of Urology, Queen's University and Kingston General Hospital, Kingston, Ontario Canad. Med. Ass. J., 126: 1420-1421 (June 15) 1982
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factors as well. He also showed that blood pressure measurements in children do not have sufficient predictive value to justify prophylactic treatment in the hopes of avoiding adult hypertension. He supported efforts to obtain more accurate data on the subject but condemned any sweeping changes in the dietary habits of children in general. T.D.A. 1 figure, 11 references
Editorial comment. Blood pressure determinations in children are especially important since such a high proportion of those with hypertension have a renal and, therefore, potentially curable cause. There is a growing consensus that if blood pressure can be maintained in the normal range by whatever means all the sequelae of hypertension will be avoided. L.R.K. Renovascular Hypertension in the Patient With Severe Atherosclerosis
ies, with occlusion near the origin of the artery supplying the lower pole. Also, a 2 cm. right adrenal mass was detected during the capillary phase. The patient was hyperreninemic and had elevated plasma aldosterone levels in the sodium replete state. The ratio of plasma renin activity in blood from the left compared to that from the right renal vein was 1.8 to 1. At an operation a right adrenal pheochromocytoma and a ligated left renal artery were found. The adrenal tumor was removed and left nephrectomy was done. There was microscopic evidence of ischemic damage to the kidney. M.G.F. 5 figures, 34 references Parallel Adrenal and Renal Abnormalities in Young Patients With Essential Hypertension
R. E. FRY AND W. J. FRY, Department of Surgery, The University of Texas Health Science Center, Dallas, Texas
G. H. WILLIAMS, M. L. TUCK, J. M. SULLIVAN, R. G. DLUHY AND N. K. HOLLENBERG, Departments of Medicine and Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
Arch. Surg., 117: 938-941 (July) 1982
Amer. J. Med., 72: 907-915 (June) 1982
Patients with renovascular hypertension and widespread atherosclerosis represent a special problem in management. Surgical intervention is associated with a much higher morbidity and less satisfactory outcome than generally is seen in patients with disease limited to the renal artery. Despite this past experience, however, 22 such patients were subjected to a surgical attack upon the renal artery under controlled conditions, which included preoperative intravenous vasodilators and fluid replacement while being monitored by a Swari-Ganz catheter. There were no operative deaths. Ao;rtorenal bypass was performed on 17 patients, nephrectomy was done on 4 with thrombosed renal vessels and a variety of other procedures was done on occasion. Of all patients 95 per cent were either cured or improved, average blood pressure mea3urements decreasing from 211/123 to 136/81. All 4 patients with impaired renal function improved postoperatively and the 1 patient on dialysis was able to discontinue this after the operation. The authors conclude that widespread atherosclerosis should not categorically contraindicate surgical intervention in renovascular hypertension. T.D.A. 4 figures, 12 references
It has been observed that some patients with essential hypertension have decreased adrenal response to angiotensin II and in unrelated studies renal perfusion is unusually high in some patients. The renin-angiotensin system is the major determinant of aldosterone release and renal perfusion in normal men under the conditions of those studies. The present study in 18 young patients with recent onset of essential hypertension represents a coordinated approach with simultaneous assessment of cardiovascular, renal and endocrine factors during periods of high sodium intake, low sodium intake and shortterm volume depletion (induced by restricted sodium and furosemide) to determine whether these abnormalities are associated. During the 2 diets all of the variables measured were in the normal range except for blood pressure and peripheral resistance. However, the aldosterone secretory response to diureticinduced volume depletion on a low sodium diet was almost absent in 9 nonresponders compared to normal aldosterone increments in the other 9 patients. Also renal blood flow was significantly higher in the former 9 patients during a high sodium intake and a restricted sodium intake. Normally, control of angiotensin release by the adrenal and renal perfusion is dominated by angiotensin. Parallel blunting of the aldosterone and the renal vascular response despite appropriate and normal plasma renin activity confirms the impression that the abnormality resides in the interaction between angiotensin II and its receptors. It is suggested that there may be a parallel abnormality of the renal vasculature in these same patients. M.G.F. 5 figures, 3 tables, 26 references
Persistent Hypertension After Resection of a Pheochromocytoma
K. M. LEIDMERER AND J.M. KISSANE, Departments of Internal Medicine, Radiology, and Pathology, Washington University School of Medicine, St. Louis, Missouri Amer. J. Med., 73: 97-104 (July) 1982 A clinicopathologic conference is presented. A 23-year-old woman who presented initially with palpitations and hypertension had undergone removal of a left adrenal pheochromocytoma at another hospital 5 months earlier. Because of persistent hypertension and hypokalemia she was referred for further evaluation. Urine and plasma catecholamine levels were elevated. A computerized tomography scan revealed a 2 cm. mass within the right adrenal gland and the left kidney appeared smaller than the right kidney. An excretory urogram showed atrophy of the lower pole of the left kidney. The right kidney contributed two-thirds of the total renal function by radionuclide renal function study. Arteriography demonstrated 2 left renal arter-
TRANSPLANTATION Results of Renal Transplantation in a Small Centre D. LUDWIN, A. MORALES, T. A. SALERNO, M. COHANIM, M.A. SINGER AND P. A. F. MORRIN, Division of Nephrology, the Division of Vascular Surgery and the Department of Urology, Queen's University and Kingston General Hospital, Kingston, Ontario Canad. Med. Ass. J., 126: 1420-1421 (June 15) 1982
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