[Renovascular hypertension. Studies of 16 cases with long-term follow-up]

Surgical correction of renovascular hypertension was studied in 16 patients. In all the patients severe high blood pressure and stenosis of at least one renal artery was demonstrated; in 14 patients plasma renin activity (PRA) in renal veins and peripheral blood was measured. All cases were followed for 36 to 48 months after surgical treatment. Blood pressure was normalized after surgical treatment (2 aortorenal bypasses, 2 nephrectomies and 7 autotransplants) in 7 patients, all of them had hyperreninemia, hypersecretion from the stenotic kidney and suppression of the contralateral kidney. In one patient with stenosis of one renal artery, blood pressure was normalized after surgery, even though no alterations in renin secretion was demonstrated. Surgery (1 bypass, 2 nephrectomies, 1 autotransplant and 1 aortorenal anastomosis) induced a decrease in blood pressure in five patients, all had normal PRA in peripheral blood and hypersecretion from the stenotic kidney. Three patients remained hypertensive in spite of nephrectomy of the stenotic kidney all had hyperreninemia without lateralization. In two patients renal failure was evident from the time they entered the study; both had hyperreninemia, lateralization and suppression of the contralateral kidney, one improved with nephrectomy of stenotic kidney and hemi-nephrectomy of the contralateral and the other remained hypertensive after nephrectomy. The initial status of renin secretion has prognostic value for the response to surgical treatment of renovascular hypertension.