Renin-dependent hypertension caused by nonfocal stenotic aberrant renal arteries: proof of a new syndrome.
We have identified 2 relatively young patients with significant hypertension, an elongated single aberrant renal artery supplying blood to a renal segment, and evidence for localization of the elevated plasma renin activity to the side and vein draining the affected kidney. Furosemide-induced diuresis and acute oral captopril stimulated the renal vein/contralateral renin ratios to 4.3:1 and 6.5:1 in patients 1 and 2, respectively. These renal vein ratios are significantly higher than normal (>3:1 under similar conditions). Partial resection of the portion of the kidney affected by the aberrant tortuous artery led to a marked reduction in blood pressure in patient 1. Patient 2, not an operative candidate, responded satisfactorily to use of a converting enzyme inhibitor, which helped to confirm the dependency of the blood pressure on the abnormal flow relationship existing within that aberrant artery and the kidney. We believe these 2 patients are representative of a small but distinct subgroup within the larger number of patients with elongated single or multiple renal aberrant arteries. Each aberrant artery had no focal stenosis, although a decrease in flow relative to the tissue perfusion demands was apparent from the marked activation of the renin-angiotensin system in the venous system draining that artery. The increased length of such vessels may contribute to their decreased flow, although their average diameter may reside just above such a critical value for a normal length vessel. This new syndrome, involving more than one component of the flow/resistance relationship, has been overlooked when renin-dependent forms of hypertension are considered.
Kem
David C
DC
Department of Internal Medicine, Cardiac Arrhythmia Research Institute, University of Oklahoma Health Sciences Center, VA Medical Center, Oklahoma City, OK, USA. david-kem@ouhsc.edu
Lyons
Daniel F
DF
Wenzl
James
J
Halverstadt
Donald
D
Yu
Xichun
X
D000293:Adolescent; D000792:Angiography; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D002216:Captopril / Q000627:therapeutic use; D002675:Child, Preschool; D004231:Diuresis; D004232:Diuretics / Q000627:therapeutic use; D005260:Female; D005665:Furosemide / Q000627:therapeutic use; D006801:Humans; D006973:Hypertension / Q000209:etiology* / Q000503:physiopathology / Q000601:surgery; D007668:Kidney / Q000601:surgery; D008297:Male; D011877:Radionuclide Imaging; D012077:Renal Artery / Q000002:abnormalities* / Q000000981:diagnostic imaging; D012078:Renal Artery Obstruction / Q000150:complications*; D012082:Renal Veins; D012083:Renin / Q000097:blood*; D013577:Syndrome
D000806:Angiotensin-Converting Enzyme Inhibitors; D004232:Diuretics; D005665:Furosemide; D002216:Captopril; D012083:Renin