• Serial renal function studies were performed on 41 patients with renovascular hypertension (RVH) secondary to atherosclerotic renal artery disease who had been randomly selected for nonoperative management. In 19 patients, serum creatinine levels increased between 25% and 120%. The glomerular filtration rates dropped between 25% and 50% in 12 patients. Fourteen patients (37%) lost more than 10% of renal length. In four patients (12%), a significant stenosis progressed to total occlusion. Seventeen patients (41%) had deterioration of renal function or loss of renal size that led to operation. One patient required removal of a previously reconstructable kidney. Of the 17 patients with deterioration, 15 had acceptable blood pressure (BP) control during the period of nonoperative observation. Progressive deterioration of renal function in nonoperatively treated patients with atherosclerotic renal artery stenosis and RVH is common, and occurs even in the presence of BP control with drugs. ( Arch Surg 1981;116:1408-1415.

Renovascular Hypertension: Anatomic and Renal Function Changes During Drug Therapy

excerpt Demonstration of a stenotic renal artery in a hypertensive patient has become commonplace. The assumption has often been made that the stenosis has been responsible for the hypertension. There is, however, very little information available concerning the existence of similar abnormalities in patients who are normotensive. Most of the angiograms which have been obtained in our institution (The Henry Ford Hospital) were indicated because of various manifestations of peripheral vascular disease, and this group of patients thus includes many normotensives. Among these normotensive subjects renal arterial disease of some type was found in 98 instances (32 per cent). The angiograms, clinical records, excretory urograms and, where available, isotope renograms, surgical findings, and pathologic reports of 500 patients have been studied; 409 of this number had been subjected to angiography because of a variety of vascular problems such as abdominal aneurysm, occlusive vascular disease, and various entities...

Aniography of the renal areas including a comparative study of renal arterial stenoses in patients with and without hypertension.

Renal handling of insulin was studied over plasma insulin levels of 6 to 40 μU per milliliter in 13 patients by renal-vein catheterization. The kidney in normal subjects and 7 patients with moderate renal insufficiency — glomerular filtration rate (GFR) over 22.5 ml per minute per kidney per 1.73 M2 — removed 39 ± 4 per cent (SD) of the insulin from arterial plasma. Severe renal insufficiency (GFR less than 6) reduced insulin uptake to 9 per cent in four subjects, two with diabetic glomerulosclerosis. Mean GFR in normal subjects was 61 ± 11 (SD) and renal insulin extraction —renal plasma flow (RPF) × % uptake — was 106 ± 28 (SD). These findings suggest that a decreased uptake of insulin by damaged kidneys accounts in part for the diminished insulin requirements seen in patients with diabetic glomerulosclerosis and that all the renal uptake of insulin cannot be explained by glomerular filtration alone.

https://www.nejm.org/doi/pdf/10.1056/NEJM197001222820402?listPDF=true

Effect of renal disease on renal uptake and excretion of insulin in man.

Ten years experience with the surgical management of renovascular hypertension.

Vascular occlusive disease poses a threat to kidney viability, but whether the events leading to injury and eventual fibrosis actually entail reduced oxygenation and regional tissue ischemia is unknown. Answering this question has been difficult because of the lack of an adequate method to assess tissue oxygenation in humans. BOLD (blood oxygen-level-dependent) magnetic resonance imaging detects changes in tissue deoxyhemoglobin during maneuvers that affect oxygen consumption, therefore this technique was used to image and analyze cortical and medullary segments of 50 kidneys in 25 subjects undergoing magnetic resonance (MR) angiography to diagnose renal artery stenosis (RAS). Magnetic rate of relaxation (R2*) positively correlates with deoxyhemoglobin levels and was therefore used as a surrogate measure of tissue oxygenation. Furosemide was administered to examine the effect of inhibiting energy-dependent electrolyte transport on tissue oxygenation in subjects with renovascular disease. In 21 kidneys with normal nephrograms, administration of furosemide led to a 20% decrease in medullary R2* (P < 0.01) and an 11.2% decrease in cortical R2*. In normal-size kidneys downstream of high-grade renal arterial stenoses, R2* was elevated at baseline, but fell after furosemide. In contrast, atrophic kidneys beyond totally occluded renal arteries demonstrated low levels of R2* that did not change after furosemide. In kidneys with multiple arteries, localized renal artery stenoses produced focal elevations of R2*, suggesting areas of deoxyhemoglobin accumulation. These results suggest that BOLD MR coupled with a method to suppress tubular oxygen consumption can be used to evaluate regional tissue oxygenation in the human kidney affected by vascular occlusive disease.

Frederick B. Hendricks

Papers

Functional characteristics of renovascular hypertension.

Percutaneous needle biopsy of the testis.

A New Disposable Prostatic Biopsy Needle

Metabolic aspects of the counterbalance theory in hydronephrosis.

Salvage ct guided brachytherapy for recurrent prostate cancer