[Renovascular hypertension with renal failure: value of renal revascularization]

The purpose of this work was to determine the effects of renal revascularization on blood pressure and renal function in 9 patients with arterial stenosis involving both kidneys (7) or a solitary kidney (2). There were five women and four men with a mean (SD) age for 64.5 +/- 7 years. The duration of hypertension ranged from 2 to 28 years (mean = 12 +/- 8). Blood pressure ranged from 210/100 to 260/150 mmHg, despite the use of three or more antihypertensive agents in 7 cases. The serum creatinine level, on presentation, ranged from 160 to 265 mumol/l (mean = 198 +/- 30 mumol/l). Intravenous pyelograms were not suggestive of renovascular disease in 4 of 7 cases. Digital angiography or arteriography demonstrated severe stenosis of the artery of the solitary kidney in 2 patients, severe bilateral atherosclerotic disease in 7 patients, three of them had complete occlusion of a main renal artery. During hospitalization, therapy with captopril (5 patients) or minoxidil (1 patient) lowered blood pressure in 3 cases, but induced a marked increase in serum creatinine level in 4 cases. In two patients, medically treated, severe and rapidly progressive impairment of renal function was observed. The seven remaining patients underwent surgical revascularization (two after unfructuous percutaneous transluminal angioplasty). One died 45 days later. Blood pressure control with diastolic blood pressure of 100 mmHg or less was achieved in the other six, although each patient continued to require antihypertensive medication (bitherapy: 2, monotherapy: 4).(ABSTRACT TRUNCATED AT 250 WORDS)