Prediction of blood pressure from plasma renin activity in reflux nephropathy

As there is a 10% risk of hypertension developing in children with reflux nephropathy and the renin-angiotensin system has been implicated in its aetiology, a long term prospective study has been undertaken to explore the relationship between plasma renin activity (PRA) and blood pressure in such patients. In 1978, of 100 normotensive children with reflux nephropathy 8% were shown to have PRA above normal. Five years later of 85 subjects suitable for analysis 13% had increased PRA and it was shown that PRA and blood pressure SD scores significantly increased. The present study refers to the 10 year follow up in which 95 of the original group were traced but eight of these were unavailable for study and 28 others were excluded from analysis because of extraneous factors that might influence blood pressure or PRA. Results therefore on 59 have been analysed. PRA was above normal in 13/59 (20%) subjects, and PRA and blood pressure SD scores had further increased. The data continue to support the role of the renin-angiotensin system in the observed rise of blood pressure in reflux nephropathy, but individual PRA measurements do not appear so far to predict reliably the onset of hypertension in affected patients.