Renal failure with posttransplant renin-angiotensin mediated hypertension

Ten days after receiving a kidney transplant, severe hypertension and renal failure developed in a patient with a previously functioning graft. Although moderate blood pressure control was achieved with dialysis and antihypertensive medications, the graft did not function well. A trial of sar-ala-angiotensin II (an angiotensin II antagonist) was associated with a dramatic fall in blood pressure. Subsequently, the patient's own two kidneys were removed, the blood pressure fell to normal on the operating table, and within days graft function improved. The possible explanation for the changes in graft function, including angiotensin II-mediated changes of glomerular filtration rate, are discussed.