Surgical Treatment in Renovascular Hypertension

Cho, Kyu Wan; Kim, Kee Soo

Abstract

In the past 8 years, strides have been made in the diagnosis and treatment of renovascular lession which induces hypertension. The most significant methods are differential renal function studies. excretory urography. redioactive renogrsm. and renal angiogram in the field of diagnosis and nephrectomy, by-pass graft, and endarterectomy including vein patch graft are the most significant in the treatment of renovascular hypertension. But simple excretory urography is. still of great help in screening large numbers of patients, and nephrectomy is used in one half the patients. These advances have been a natural outgrowth of early work by Gold blatt, Page. and others. The accepted and relatively we11-established theory is, of course. that reduced renal blood flow leads to renal ischemia which in turn stimulates production of Renin by the kidney. Renin is an enzyme which reacts with alpba-2 globulin to liberate the decapeptid angiotensin 1, Neither renin nor angiotensin I is a pressure substance, but still another enzyme rapidly converts angiotensin l to an octapeptide, angiotensin II, which is the most potent pressure substance known.
CASE REPORT
S. H. Chung. a 10 year-old Korean girl. was admitted with severe headache and unconsciousness of only 3 weeks. duration. B100d Pressure was 200/140. The urogram disclosed the left kidney measured l1 cm by 6 cm. With an appearance time of the contrast material at 5 minutes. while the right kidney measured 8.5cm by 4cm and contrast material did not appear until 2 hours and the pelvis. calycial systems were quite normal on both kidneys by retrograde pyelogram. Exploration revealed a smaller right kidney with almost total obliteration of the renal artery in dense fibrotic reaction. Nephrectomy was done and the b1ood pressure dropped. to l20/60 within t8 hours. The kidney substance appeared to be good and biopsy of the kidney revealed essentially normal renal architecture.